Keveyis

Drug - Keveyis™ (dichorphenamide) [Taro Pharmaceuticals, U.S.A.]

March 2016

Therapeutic area - Primary hyperkalemic periodic paralysis, primary hypokalemic periodic paralysis and related variants

Approval criteria

• Patient must be 18 years of age or older AND
• Patient has one of the following diagnoses:  
  • Primary hyperkalemic periodic paralysis OR 
  • Primary hypokalemic periodic paralysis OR
  • Related variants AND
• Patient has tried and failed acetazolamide

Denial criteria

• Patient has one of the following contraindications:
  • Hepatic insufficiency OR
  • Severe pulmonary obstruction OR
  • Hypersensitivity to sulfonamide OR
  • Concomitant use of aspirin exceeding 325 mg/day

Quantity limit

Maximum of 136 tablets per 34 days

Duration of approval

3 months

Renewal criteria

Evaluate patient’s response to Keveyis and provide justification for continuation.

Questions?

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