Anticonvulsants
Indications for Prior Authorization
Briviact (brivaracetam)
-
For diagnosis of Partial-Onset Seizures
Indicated for the treatment of partial-onset seizures in patients 1 month of age and older.
Criteria
Briviact tablet, oral solution
Step Therapy
Length of Approval: 12 Month(s)
- BOTH of the following:
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Trial and failure (of a minimum 30-day supply), contraindication or intolerance to one of the following generics:
- lamotrigine immediate-release (IR)
- levetiracetam IR
- levetiracetam extended-release (ER)
- oxcarbazepine IR
- topiramate IR
- For continuation of prior therapy
P & T Revisions
2024-03-18, 2023-02-27, 2022-02-04, 2021-10-13, 2021-09-27, 2021-05-18, 2021-03-03, 2020-02-19, 2019-12-10
References
- Briviact Prescribing Information. UCB, Inc. Smyrna, GA. September 2021.
Revision History
- 2024-03-18: Annual Review
- 2023-02-27: Annual Review - no criteria changes
- 2022-02-04: Annual Review - Addition of diagnosis check
- 2021-10-13: Updated indication section due to Briviact expanded approval to age 1 month and up. No change to clinical criteria.
- 2021-09-27: EHB specific guideline, added to EHB formulary, removed from OptumRx formulary. no changes to criteria
- 2021-05-18: EHB specific guideline, added to EHB formulary, removed from OptumRx formulary. no changes to criteria
- 2021-03-03: 2021 Annual Review, no changes to criteria.
- 2020-02-19: 2020 Annual Review, no changes to criteria.
- 2019-12-10: New EHB guideline that targets Briviact.
HEALTHY LIVING