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Limited coverage criteria – perampanel

Last updated on March 20, 2025

 

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Generic name 

perampanel

Strength & form

2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12 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 1 other anti-epileptic drug) for partial-onset seizures

AND

After at least 4 other anti-epileptic medications have been tried without success (names of previously tried therapies and response must be indicated on Special Authority request)

Indefinite

For the treatment of primary generalized tonic-clonic seizures in adults and to be used:

As adjunctive therapy (used in combination with at least 1 other anti-epileptic drug) for primary generalized tonic-clonic seizures

AND

After at least 2 other anti-epileptic medications have been tried without success

Indefinite

Practitioner exemptions

  • No practitioner exemptions

Special notes

  • Special Authority requests should include documentation stating which other anti-epileptic drugs have been tried in adequate doses
  • Patients should be under the care of a prescriber experienced in the treatment of epilepsy

Special Authority request form(s)