DAYVIGO (lemborexant)

DAYVIGO (lemborexant)

SELF-ADMINISTRATION

Indications for Prior Authorization:

• Indicated for the treatment of adult patients with insomnia, characterized by difficulties with sleep onset and/or sleep maintenance

Patients must meet the following criteria for the indication(s) above:

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

Dosing:

• 5 mg once daily at bedtime with at least 7 hours before planned time of awakening
• Max: 10 mg once daily

Authorization is Not Covered for the Following:

• The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

Approval:

• 1 year

Review History:

• 8/1/20- Original review

References:

• DayVigo Prescribing Information. Eisai Inc. Woodcliff Lake, NJ. December 2019.