Epidiolex and Diacomit Clinical Prior Authorization Criteria Updates

Epidiolex and Diacomit Clinical Prior Authorization Criteria Updates

VDP regularly updates the clinical prior authorization criteria. These updates are necessary to help align VDP drug policies and prior authorization approval criteria with the latest information available on drug information packets, the federal or state regulations.

On October 1, 2020, ICD-10 code G40.83 becomes available for Dravet Syndrome with the following sub-codes:
  • G40.833 for Dravet Syndrome, intractable with status epilepticus
  • G40.834 for Dravet Syndrome, intractable without status epilepticus. 
FirstCare will update the clinical edits for Epidiolex and Diacomit to include these ICD-10 codes on October 1, 2020. On July 31, 2020, the FDA approved Epidiolex for the treatment of seizures associated with tuberous sclerosis complex in patients one year of age and older. FirstCare will add this new indication to the Epidiolex clinical edit on October 1, 2020.

For FirstCare’s Clinical Edits click here.

Send to a Friend

* Required field

Captcha The math problem above is intended to reduce spam.