Brivaracetam (Briviact) coverage criteria for partial-onset seizures
Customize your policy alerts
Sign up for all Neighborhood Health Plan of Rhode Island policy alerts
Know when Neighborhood Health Plan of Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
Criteria for initial approval, continuation, quantity limits, and coverage duration for brivaracetam (Briviact) for members (Medicaid scope) beginning 2026-07-01.
No material clinical or coverage changes in this revision.
Coverage Criteria
inv-01: Initial Therapy
Covered when ALL of the following are met:
All listed conditions must be satisfied for initial authorization.
inv-02: Continuation Therapy
Continuation covered when ONE of the following is met:
Satisfying either condition allows continuation within quantity limits.
There are no other explicit exclusions listed in this policy beyond the defined coverage criteria. Coverage is governed by the specific initial and continuation requirements described in the policy; absence of those requirements is the basis for denial rather than any separate exclusion list.
If the required documentation is not provided, authorization cannot be granted. Specifically, missing documentation of the patient age (must be ≥1 month), lack of evidence that the prescriber is a neurologist or that the prescription was written in consultation with a neurologist, absence of documentation of trials of at least two other antiepileptic drugs (or documented intolerable side effects to two agents), or failure to document seizure frequency will preclude approval under the initial authorization criteria.
Initial Therapy Requirements
inv-11: Initial Therapy
Initial authorization requirements for brivaracetam:
All criteria required for initial approval.
Continuation Therapy Requirements
inv-12: Continuation Therapy
Conditions for continuation of brivaracetam coverage within quantity limits:
Evidence of ongoing use or clinical benefit required for continuation within quantity limits.
Provider Actions & Requirements
Initial authorization — required prescriber, age, indication, prior trials, counseling, and seizure-frequency documentation
Initial authorization will be granted only when all listed conditions are met: the prescriber is a neurologist or the prescription is made in consultation with a neurologist; the patient is at least 1 month old; the medication is prescribed for treatment of partial‑onset seizures; documentation shows trials of at least two other antiepileptic drugs titrated to appropriate maintenance doses or documented failures due to intolerable side effects; the prescriber has counseled the patient on neurological, psychiatric, and serious dermatologic adverse reactions; and documentation of seizure frequency is provided.
- Prescriber specialty: neurologist or in consultation with a neurologist
- Minimum age: ≥ 1 month
- Indication: partial‑onset seizures
- Prior therapy: trial of ≥ 2 other AEDs titrated to maintenance dose or documented failure/intolerance
- Counseling: prescriber counseled patient on neurological, psychiatric, and serious dermatologic adverse reactions
- Documentation: seizure frequency provided
Step‑therapy: trial of ≥2 other antiepileptic drugs or documented intolerances
Prior to initiating brivaracetam, the member must have trialed at least two other antiepileptic drugs titrated to appropriate maintenance doses or have documented intolerable side effects or failures to those agents.
- Trial of at least two other antiepileptic drugs titrated to an appropriate maintenance dose, OR
- Documented failure of at least two other antiepileptic drugs due to intolerable side effects
Required clinical documentation — seizure frequency and prior AED trials/intolerances
Include clinical documentation of seizure frequency and evidence of prior antiepileptic drug trials or documented intolerances when submitting for authorization.
- Document seizure frequency
- Provide evidence of trials of at least two other AEDs titrated to maintenance dose or documented failures/intolerances
- Note that prescriber counseling on neurological, psychiatric, and serious dermatologic adverse reactions should be documented
Denial risk — missing required prior AED trials or documented intolerances
An authorization may be denied if the request does not document trials of at least two other antiepileptic drugs titrated to maintenance dose or documented failures due to intolerable side effects.
- Lack of documentation of ≥2 prior AED trials titrated to maintenance dose or documented intolerable side effects to at least two agents risks denial of initial authorization
Step Therapy Requirements
| Step | Requirement |
|---|---|
| 1 | Trial of at least two other antiepileptic drugs titrated to an appropriate maintenance dose, or documented failure of at least two other antiepileptic drugs due to intolerable side effects |
Quantity Limits
Definitions
Background
Brivaracetam (Briviact) is an antiepileptic medication authorized by this policy for the treatment of partial-onset seizures. For initial approval, the policy requires that the prescriber be a neurologist or that treatment be prescribed in consultation with a neurologist, the patient be at least 1 month old, the patient have documented trials of at least two other antiepileptic drugs titrated to maintenance dose (or documented failure due to intolerable side effects), prescriber counseling on neurological, psychiatric, and serious dermatologic adverse reactions, and documentation of seizure frequency.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.