Suvorexant (Belsomra)


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


  • 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


  • One year
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