BELSOMRA (suvorexant)

BELSOMRA (suvorexant) 

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

• Treatment of insomnia, characterized by difficulties with sleep onset and/or sleep maintenance

Prior authorization criteria:

• Diagnosis of insomnia, AND
• For patient's < 65 years old:  has tried and failed at least two preferred medications (e.g., estazolam, eszopiclone, ramelteon, temazepam, zaleplon, zolpidem) as confirmed by medical record documentation and/or prescription claims history

Dosing:

• 10 mg once per night taken within 30 minutes of going to bed, with at least 7 hours remaining before the planned time of awakening. 
• Max: 20 mg once daily

Approval:

• One year