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DrugKeveyis™ (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.


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

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