CurrentCignaPolicy CNF036

Antiseizure Medications - Oxcarbazepine Step Therapy Policy

Defines step therapy requirements for coverage of oxcarbazepine products under Cigna-administered health benefit plans, specifying Step 1 (generic oxcarbazepine tablets and oral suspension) and Step 2 (Oxtellar XR and Trileptal brand and generic) and criteria for approval.

Policy Summary

PayerCigna

PolicyAntiseizure Medications - Oxcarbazepine Step Therapy Policy

Policy CodePolicy CNF036

Change TypeName update; Step 2 XR generics added; routine annual revisions

Effective Date

Next Review Date

Key ActionAt point of service, document that the patient has tried one Step 1 product (generic oxcarbazepine tablets or oral suspension) when requesting a Step 2 oxcarbazepine product; approvals are provided for 1 year.

SourceLink

POLICY UPDATE CHANGES

Policy name changed from 'Antiseizure Medications - Oxtellar XR, Trileptal Step Therapy' to 'Antiseizure Medications - Oxcarbazepine Step Therapy Policy'.

Generic oxcarbazepine extended-release tablets were added to the policy as a Step 2 medication.

Annual revisions with 'No criteria changes' on multiple review dates.

2Steps in Therapy

1 yearApproval Duration

No criteria changesMost Recent Annual Revision

Coverage Summary

Defines step therapy requirements for coverage of oxcarbazepine products under Cigna-administered health benefit plans. Policy number CNF036. Status: CURRENT. Coverage stance: covered_with_criteria — Step 2 oxcarbazepine products are covered when the criteria requiring prior use of a Step 1 product are met.

Policy Metadata

Steps in Therapy2

Approval Duration1 year

Most Recent Annual RevisionNo criteria changes

Last Review Date2026-04-15

Step Therapy Criteria

Covered when ALL of the following are met:

ALL of the following

Patient has tried one Step 1 Product
Approvals provided for 1 year
Requested medication is a Step 2 Product (Oxtellar XR or Trileptal brand or generic) OR Step 2 generic oxcarbazepine extended-release tablets

Step Definitions

ALL of the following

Step 1: generic oxcarbazepine tablets, generic oxcarbazepine oral suspension
Step 2: Oxtellar XR (brand and generic), Trileptal tablets and oral suspension

Products Named in Policy

Products Named in Policymixed

Oxtellar XR	oxcarbazepine extended-release tablets - Supernus (brand and generic)
Trileptal	oxcarbazepine tablets and oral suspension - Novartis (brand and generic)
generic oxcarbazepine tablets	immediate-release generic oxcarbazepine tablets
generic oxcarbazepine oral suspension	generic oxcarbazepine oral suspension
generic oxcarbazepine extended-release tablets	generic oxcarbazepine XR (added to policy as Step 2 medication)

Provider Actions

Prior Authorization

Step therapy requirement

At point of service, coverage for a Step 2 oxcarbazepine product requires documentation that the patient has tried one Step 1 product (generic oxcarbazepine tablets or oral suspension); approvals are provided for 1 year in duration.

Documentation Required

Support for coverage determinations

Providers must submit documentation of trial of one Step 1 product when requesting a Step 2 product; coverage determinations consider the terms of the applicable benefit plan document and any applicable laws/regulations.

Background & Evidence

Oxcarbazepine (tablets and oral suspension) is indicated for treatment of partial seizures in various age groups; oxcarbazepine extended-release (XR) is indicated for treatment of partial seizures in patients ≥ 6 years of age. Oxcarbazepine is available in immediate-release and extended-release formulations; oxcarbazepine XR administered once daily is not bioequivalent to the same total dose of the immediate-release formulation given twice daily at steady state. This policy aims to encourage use of a Step 1 Product prior to use of a Step 2 Product and to require documentation of trial of a Step 1 product at point of service; approvals are provided for 1 year.

Source	Reference
Trileptal PI	Novartis prescribing information, September 2025
Oxtellar XR PI	Supernus prescribing information, August 2024

Step 1 Product: generic oxcarbazepine tablets or generic oxcarbazepine oral suspension.

Step 2 Product: Oxtellar XR (brand and generic), Trileptal tablets and oral suspension, and generic oxcarbazepine extended-release tablets.

Revision History

09/18/2024addition

Generic oxcarbazepine extended-release tablets were added to the policy as a Step 2 medication.

04/03/2024annual_revision

Annual revision: No criteria changes.

04/02/2025annual_revision

Annual revision: No criteria changes.

04/15/2026annual_revisionLatest

Annual revision: No criteria changes.

09/18/2024name_change

Policy name changed from 'Antiseizure Medications - Oxtellar XR, Trileptal Step Therapy' to 'Antiseizure Medications - Oxcarbazepine Step Therapy Policy'.

Policy Summary

PayerCigna

PolicyAntiseizure Medications - Oxcarbazepine Step Therapy Policy

Policy CodePolicy CNF036

Change TypeName update; Step 2 XR generics added; routine annual revisions

Effective Date

Next Review Date

SourceLink

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