Epidiolex (cannabidiol) — United Healthcare
seizures associated with Lennox-Gastaut syndrome
Preferred products
- Divalproex
- Lamotrigine
- Topiramate
- Valproic acid
Initial criteria
- Diagnosis of seizures associated with Dravet syndrome OR tuberous sclerosis complex OR Lennox-Gastaut syndrome
- For Dravet syndrome or tuberous sclerosis complex: no trial requirement
- For Lennox-Gastaut syndrome: history of ≥ 8 week trial of at least two generic anticonvulsants (e.g., divalproex, lamotrigine, topiramate, valproic acid)
- 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