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Zolpidem tartrate SL Tab 1.75 MG — Blue Cross Blue Shield of Oklahoma

insomnia

Preferred products

  • Ambien
  • Ambien CR
  • Lunesta
  • Rozerem
  • Silenor

Initial criteria

  • Member must have a diagnosis of insomnia.
  • Member must have tried and failed or have contraindication or intolerance to at least one preferred agent (Ambien, Ambien CR, Lunesta, Rozerem, Silenor).