Limited coverage criteria – rufinamide

Last updated on June 26, 2026

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Generic name		rufinamide
Strength & form		100 mg, 200 mg, 400 mg tablet

Special Authority criteria	Approval period
For the treatment of Lennox-Gastaut syndrome (LGS), as adjunctive therapy in patients who are currently taking at least two other anti-epileptic drugs, when the Special Authority request is submitted by a neurologist.	Indefinite

Practitioner exemptions

None

Special notes

None

Special Authority request form(s)

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

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Limited coverage criteria – rufinamide

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)