Motpoly XR (lacosamide extended release) (Revised)

By August 27, 2025: Billing and prior authorization teams must implement this new Motpoly XR prior authorization requirement in the billing system. Specifically: (1) Configure system to require prior authorization for all Motpoly XR pharmacy claims under Medicare Advantage; (2) Update prior auth submission templates to capture required clinical documentation including diagnosis (partial-onset seizures OR generalized tonic-clonic seizures), patient weight (must be ≥50 kg), and evidence of prior treatment failure with generic lacosamide AND at least one other specified antiepileptic drug (levetiracetam, lamotrigine, carbamazepine, zonisamide, divalproex, gabapentin, or topiramate); (3) Notify providers and patient care coordinators of the updated criteria; (4) Train staff on the two separate approval pathways (partial-onset vs. generalized tonic-clonic) with their different combination therapy requirements. Failure to obtain prior authorization before dispensing will result in claim denials for Medicare Advantage members.