Lumryz — CareFirst (Caremark)

Initial criteria

• Member is 7 years of age or older
• Diagnosis of narcolepsy is confirmed by a sleep lab evaluation
• Member has a baseline history of at least 3 cataplexy attacks per week
• Medication is prescribed by or in consultation with a sleep specialist (e.g., neurologist experienced with sleep disorders, physician certified in sleep medicine)

Reauthorization criteria

• Beneficial response to treatment as defined by a decrease in cataplexy episodes from baseline

Approval duration

12 months