Limited coverage criteria – eslicarbazepine acetate

Last updated on May 20, 2025

 

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Generic name

eslicarbazepine acetate

Strength & form

200 mg, 400 mg, 600 mg, 800 mg tablet

Special Authority criteria

Approval period 

For the treatment of partial-onset seizures in adults 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 the 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 request form(s)