PA applies to new starts only.

Fintepla will be approved when ALL of the following are met:

1. BOTH of the following: 
   1. The patient has a diagnosis of seizures associated with Dravet syndrome (DS) or Lennox-Gastaut syndrome (LGS) AND 
   2. The patient is within the FDA labeled age for the requested medication AND 
2. ONE of the following: 
   1. There is evidence of a claim that the patient is currently being treated with the requested medication within the past 180 days OR 
   2. The prescriber states the patient is currently being treated with the requested medication OR 
   3. ALL of the following: 
      1. An echocardiogram assessment will be obtained before and during treatment with the requested medication, to evaluate for valvular heart disease and pulmonary arterial hypertension AND 
      2. The prescriber is a specialist in the area of the patient’s diagnosis (e.g., neurologist) or the prescriber has consulted with a specialist in the area of the patient’s diagnosis AND 
      3. The patient does NOT have any FDA labeled contraindications to the requested medication AND 
3. ONE of the following: 
   1. The requested quantity (dose) does NOT exceed the program quantity limit OR 
   2. BOTH of the following: 
      1. The requested quantity (dose) is greater than the program quantity limit AND 
      2. The prescriber has provided information in support of therapy with a higher dose for the requested indication 

Length of Approval: 12 months