Keveyis — Medica

Initial criteria

• Patient has a confirmed diagnosis of primary hypokalemic periodic paralysis by meeting at least ONE of the following: (a) serum potassium concentration < 3.5 mEq/L during a paralytic attack; OR (b) family history of the condition; OR (c) genetically confirmed skeletal muscle calcium or sodium channel mutation
• Prescriber has excluded other reasons for acquired hypokalemia (e.g., renal, adrenal, thyroid dysfunction; renal tubular acidosis; diuretic or laxative abuse)
• Patient has had improvements in paralysis attack symptoms with potassium intake
• Patient has tried oral acetazolamide therapy
• According to prescriber, acetazolamide therapy did not worsen paralytic attack frequency or severity
• Medication is prescribed by or in consultation with a neurologist or a physician who specializes in the care of patients with primary periodic paralysis (e.g., muscle disease specialist, physiatrist)

Reauthorization criteria

• Patient is currently receiving dichlorphenamide and has responded to dichlorphenamide (e.g., decrease in frequency or severity of paralytic attacks) as determined by the prescriber

Approval duration

Initial: 2 months; Reauthorization: 1 year