Suvorexant (Belsomra)

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