Briviact
Drugs - Briviact ® (brivaracetam) [UCB, Inc.]
August 2019
Therapeutic area - Antiepileptic
Approval criteria
- Patient is 4 years of age or older AND
- Patient has a diagnosis of partial-onset seizures AND
- Patient has tried and failed THREE or more anti-epileptic drugs which include: gabapentin, lamotrigine, levetiracetam, ethosuximide, oxcarbazepine, topiramate or carbamazepine OR
- Prescriber is a neurologist AND patient has tried and failed at least TWO anti-epileptic drugs which include: gabapentin, lamotrigine, levetiracetam, ethosuximide, oxcarbazepine, topiramate or carbamazepine AND
- Patient must not have one of these conditions:
- Chronic hepatic impairment (Child-Pugh class A, B or C)
- End stage renal disease (ESRD)
- Currently on dialysis AND
- Request for Briviact to be co-administered with levetiracetam will not be accepted
Quantity limit
- Tablets (all strengths): 68 tablets per 34 days
- Oral solution: 4 mg/kg per day
- For pediatric patients 4 years to less than 16 years of age, the patient’s weight (in kg) must be submitted at time of request
Background information
BRIVIACT (brivaracetam) is FDA-approved for the treatment of partial-onset seizures in patients 4 years of age and older. The safety and effectiveness of BRIVIACT injection in pediatric patients less than 16 years of age have not been established. BRIVIACT injection is indicated for when oral administration is temporarily not feasible. BRIVIACT injection is not subject to prior authorization. In addition, BRIVIACT had no added therapeutic benefit when co-administered with levetiracetam.
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411
