Ztalmy — Medical Mutual
Seizures associated with Cyclin-Dependent Kinase-Like 5 (CDKL5) Deficiency Disorder
Initial criteria
- Patient is age ≥ 2 years
- Patient has molecularly confirmed pathogenic or likely pathogenic mutation in the CDKL5 gene
- Medication is prescribed by or in consultation with a neurologist
- Patient has tried at least two antiseizure medications, each from a different pharmacologic class, unless an intolerance or contraindication exists [documentation required]
Reauthorization criteria
- Response to therapy is required for continuation of therapy
Approval duration
initial: 6 months; reauth: 1 year