Epidiolex — Medical Mutual

Initial criteria

• Patient is age ≥ 1 year
• Patient has tried or is concomitantly receiving one antiepileptic drug used for Lennox-Gastaut Syndrome OR patient has tried or is concomitantly receiving at least two other antiseizure medications
• Medication is prescribed by or in consultation with a neurologist

Reauthorization criteria

• Patient is currently receiving Epidiolex and is responding to therapy (e.g., reduced seizure severity, frequency, and/or duration) as determined by the prescriber

Approval duration

1 year