skip to content
Primary navigation

Briviact

Drugs - Briviact ® (brivaracetam) [UCB, Inc.]

November 2017

Therapeutic area - Antiepileptic

Approval criteria

  • Patient is 16 years of age or older AND
  • Patient has a diagnosis of partial-onset seizures AND
  • Patient has tried and failed THREE or more anti-epileptic drugs which include: gabapentin, lamotrigine, levetiracetam, ethosuximide, oxcarbazepine, topiramate or carbamazepine OR
  • Prescriber is a neurologist AND patient has tried and failed at least TWO anti-epileptic drugs which include: gabapentin, lamotrigine, levetiracetam, ethosuximide, oxcarbazepine, topiramate or carbamazepine
  • Patient must not have one of these conditions:
    • Chronic hepatic impairment (Child-Pugh class A, B or C)
    • End stage renal disease (ESRD)
    • Currently on dialysis

Quantity limit

  • Tablets (all strengths): 68 tablets per 34 days
  • Oral solution: 680 mL per 34 days

Background information

BRIVIACT (brivaracetam) is FDA-approved for the treatment of partial-onset seizures in patients 16 years of age and older with epilepsy. The safety and effectiveness of BRIVIACT in pediatric patients less than 16 years of age have not been established. BRIVIACT injection is indicated for when oral administration is temporarily not feasible. BRIVIACT injection is not subject to prior authorization.

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411

back to top