Firdapse (amifampridine) — United Healthcare
Lambert-Eaton myasthenic syndrome (LEMS)
Initial criteria
- Diagnosis of Lambert-Eaton myasthenic syndrome (LEMS)
- Patient is not receiving Firdapse in combination with similar potassium channel blockers [e.g., Ampyra (dalfampridine)]
Reauthorization criteria
- Documentation of positive clinical response to Firdapse therapy
- Patient is not receiving Firdapse in combination with similar potassium channel blockers [e.g., Ampyra (dalfampridine)]
Approval duration
12 months