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Limited coverage criteria – cannabidiol for Dravet syndrome

Last updated on December 3, 2025

 

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Generic name

cannabidiol

Brand name

 Epidiolex®

Strength & form

100 mg/mL oral solution

Special Authority criteria

Approval period

As adjunctive therapy for the treatment of seizures associated with Dravet syndrome (DS) in patients 2 years and older if ALL the following conditions are met:

  • Currently taking ONE or more anti-seizure medications (ASMs) at a stable therapeutic dose for at least 4 weeks before initiation of cannabidiol

AND

  • Treatment failure with at least THREE ASMs

AND

  • Patient has at least 4 convulsive1 seizures per 28 days2 before initiation of cannabidiol

AND

  • Special Authority request is submitted by a neurologist

Indefinite

Practitioner exemptions

  • None

Special notes

  • Special Authority coverage will not be provided for cannabidiol in patients concurrently using cannabis products (i.e., prescription or recreational) or other cannabinoid-based medications (e.g., nabilone, nabiximols)
  • Treatment with cannabidiol should be discontinued upon the occurrence of severe toxicity, lack of beneficial treatment effect, or intolerance
  • 1Convulsive seizures are defined as tonic-clonic, tonic, clonic, or atonic seizures
  • 2Documented baseline values for seizure (e.g., convulsive seizures) must have been observed over the 28 days immediately prior to the initiation of cannabidiol. Estimates, averages, and/or remote values will not be accepted
  • Additional information expected to assist with processing of coverage requests is detailed on the forms linked below (and on the eForms published online)

Special Authority requests