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Limited coverage criteria – cannabidiol for Lennox-Gastaut 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 Lennox-Gastaut syndrome (LGS) 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 TWO ASMs

AND

  • Patient has at least 2 drop seizures1 per week2 over a 28-day period (or at least 8 drop seizures per 28 days) 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
  • 1A drop seizure is defined as an atonic, tonic, or tonic-clonic seizure involving the entire body, trunk, or head that led or could have led to a fall or injury
  • 2 Documented baseline values for seizure (e.g., drop seizures) must have been observed over the 28 days immediately prior to the initiation of cannabidiol. Estimations, averages, and/or remote values will not be accepted
  • Additional information expected to assist with the processing of coverage requests is detailed on the forms linked below (and on the eForms published online)

Special Authority requests