Aptiom (eslicarbazepine) — United Healthcare
seizures associated with cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder
Preferred products
- Carbamazepine
- Divalproex
- Gabapentin
- Lamotrigine
- Levetiracetam
- Oxcarbazepine
- Phenytoin
- Pregabalin
- Topiramate
- Valproic acid
- Zonisamide
Initial criteria
- Diagnosis of partial-onset seizures (Aptiom or Xcopri) OR seizures associated with CDKL5 deficiency disorder confirmed with genetic testing (Ztalmy)
- History of ≥ 8 week trial of at least two of the following (any release formulation qualifies): Carbamazepine, Divalproex, Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Phenytoin, Pregabalin, Topiramate, Valproic acid, Zonisamide
- AND one of the following: (a) Both documented history of persisting seizures after titration to highest tolerated dose with each medication trial AND lack of compliance ruled out; OR (b) Documentation of failure due to intolerable side effects AND reasonable efforts made to minimize side effects
Reauthorization criteria
- Continuation of prior therapy for a seizure disorder
Approval duration
12 months