Epidiolex — Medical Mutual
Treatment-Refractory Seizures/Epilepsy (CDKL5 deficiency disorder; Dup15q; Aicardi; Doose syndromes; febrile infection-related epilepsy syndromes; focal epilepsy; Sturge-Weber syndrome; lissencephaly; cortical malformation/dysplasia; epilepsy with myoclonic absences)
Initial criteria
- Patient is age ≥ 1 year
- 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