Fycompa — United Healthcare
partial-onset seizures with or without secondarily generalized seizures
Initial criteria
- Diagnosis of partial-onset seizures with or without secondarily generalized seizures OR ALL of the following: Diagnosis of primary generalized tonic-clonic seizures; 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