Limited Use Note(s)

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BRIVARACETAM25mg Tab
Reason For Use CodeClinical Criteria
548- As adjunctive therapy in the treatment of patients with partial-onset seizures (POS) who have had an inadequate response or have significant intolerance to at least 2 other less costly anticonvulsant therapies (prior or current use); AND - Patients are not receiving concurrent therapy with levetiracetam; AND - Patients are under the care of a physician experienced in the treatment of epilepsy. Note: Less costly anticonvulsant therapies may include the following: Phenytoin, carbamazepine, gabapentin, lamotrigine, vigabatrin, topiramate, etc.
LU Authorization Period: Indefinite.