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
    OR
  • 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

  1. Briviact Prescribing Information. UCB, Inc. Smyrna, GA. September 2021.

  • 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.

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