Hetlioz LQ — CareFirst (Caremark)
Nighttime Sleep Disturbances in Smith-Magenis Syndrome (SMS)
Initial criteria
- Confirmed clinical diagnosis of Smith-Magenis Syndrome
- Member has a history of sleep disturbances
- Prescribed by or in consultation with a sleep specialist (e.g., neurologist experienced with sleep disorders, physician certified in sleep medicine) or psychiatrist
Reauthorization criteria
- Member experiences improvement in the quality of sleep since starting therapy with the requested drug
Approval duration
Initial: 6 months; Reauthorization: 12 months