Limited coverage criteria – cenobamate

Last updated on May 20, 2025

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Generic name		cenobamate
Strength & form		12.5 mg, 25 mg, 50 mg, 100 mg, 150 mg, 200 mg tablet

Special Authority criteria	Approval period
For the treatment of partial-onset seizures in adults ( ≥ 18 years of age) and to be used: As adjunctive therapy (used in combination with at least ONE other anti-epileptic drug) AND After at least FOUR other anti-epileptic medications have been tried without success (names of previously tried therapies and response must be indicated on Special Authority request)	Indefinite

Special Authority criteria

Approval period

For the treatment of partial-onset seizures in adults ( ≥ 18 years of age) and to be used:

As adjunctive therapy (used in combination with at least ONE other anti-epileptic drug)

AND

After at least FOUR other anti-epileptic medications have been tried without success (names of previously tried therapies and response must be indicated on Special Authority request)

Indefinite

Practitioner exemptions

None

Special notes

Special Authority requests should include documentation stating which other anti-epileptic drugs have been tried in adequate doses. Examples of other anti-epileptic drugs may include:
- Carbamazepine
- Clobazam
- Gabapentin
- Lacosamide
- Lamotrigine
- Levetiracetam
- Phenytoin
- Topiramate
- Vigabatrin
- Valproic acid

Special Authority requests

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HLTH 5328 – General Special Authority request (PDF, 656KB)

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