Cigna + Oscar
Sylvant (siltuximab)
Drugs for Cancer : Drugs for Cancer
  • Dravet Syndrome:
    Age Requirement: >= 1
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Lennox Gastaut Syndrome (LGS):
    Age Requirement: >= 1
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Neurology: Epilepsy:
    Age Requirement: >= 1
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Diagnosis Type(s): 1 of Dravet syndrome;Seizure associated with tuberous sclerosis;Seizures Associated with Lennox-Gastaut Syndrome (LGS)
    Used as Adjunctive Treatment: Yes
    Duration of Failure or Adjunctive Treatment with Other Antiepileptic Product: N/A
    Documented history of persisting seizures after titration to highest tolerated dose of each AED.: No
    Lack of compliance as a reason for treatment failure has been ruled out: No
    Documentation of treatment failure due to intolerable side effects.: No
    Supporting Documentation Requirements: 2 of Chart Notes;Medication History
    Positive Response to Therapy Required for Reauth: No
    Treatment for Age 17 years or older: No
    Treatment for Age 1-16 years old: Yes
    History of >= to 30 day trial of other AED required: No
    Reapproval based on response: No

  • Step Therapy: ST Multiple Generics