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Banzel — United Healthcare

seizures associated with Lennox-Gastaut syndrome (LGS)

Initial criteria

  • ALL of the following: Diagnosis of seizures associated with Lennox-Gastaut syndrome (LGS); Used as adjunctive therapy; Not used as primary treatment OR continuation of prior therapy for a seizure disorder

Reauthorization criteria

  • Documentation of positive clinical response to therapy

Approval duration

12 months