Fintepla (fenfluramine) — United Healthcare
seizures associated with Dravet syndrome
Preferred products
- Divalproex
- Levetiracetam
- Topiramate
- Valproic acid
- Zonisamide
- Lamotrigine
Initial criteria
- Diagnosis of seizures associated with Dravet syndrome OR Lennox-Gastaut syndrome
- For Dravet syndrome: history of ≥ 8 week trial of at least two of the following (any release formulation qualifies): Divalproex, Levetiracetam, Topiramate, Valproic acid, Zonisamide
- For Lennox-Gastaut syndrome: history of ≥ 8 week trial of at least two of the following (any release formulation qualifies): 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