Pharmacy Prior Authorization Criteria

Flurazepam

Indications for Prior Authorization

Flurazepam

• For diagnosis of Insomnia
  Indicated for the treatment of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakening.

  Since insomnia is often transient and intermittent, short-term use is usually sufficient. Prolonged use of hypnotics is usually not indicated and should only be undertaken concomitantly with appropriate evaluation of the patient.

Criteria

Flurazepam

For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.

Prior Authorization

Length of Approval: 12 Month(s)

• Diagnosis of insomnia
AND
• Trial and failure, contraindication, or intolerance to two of the following benzodiazepines: [A]
• Estazolam
• Halcion (triazolam)
• Restoril (temazepam)

P & T Revisions

1970-01-01, 2025-12-18, 2025-05-19, 2024-05-21, 2023-03-16, 2022-03-18, 2021-09-28, 2021-05-19, 2021-03-04, 2020-03-04

References

1. Flurazepam Prescribing Information. Chartwell RX, LLC. Congers, NY. December 2023.
2. The 2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694.
3. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;1-30.

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End Notes

1. Flurazepam, estazolam, triazolam, and temazepam are only recommended for patients < 65 years old. These drugs were included on the American Geriatrics Society 2019 Beers Criteria update. [2] Flurazepam was removed in the 2023 AGS Beers Criteria update due to low utilization but is still considered potentially inappropriate in alignment with the 2019 AGS Beers Criteria. [3]

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Revision History

• 1970-01-01: No criteria change, bulk copy oRX-EHB
• 2025-12-18: no criteria changes, added IL statute operational note
• 2025-05-19: 2025 annual review: no changes.
• 2024-05-21: 2024 annual review: no criteria changes. Updated end note and references.
• 2023-03-16: Annual review: no changes to criteria.
• 2022-03-18: Annual review: no changes to criteria.
• 2021-09-28: Addition of EHB formulary to guideline, no changes to criteria
• 2021-05-19: Addition of EHB formulary to guideline, no changes to criteria
• 2021-03-04: Annual review: Background updates.
• 2020-03-04: Annual review: no updates required.

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