Lumryz — CareFirst (Caremark)
Excessive daytime sleepiness (EDS) with narcolepsy
Preferred products
- modafinil
- armodafinil
- amphetamine
- dextroamphetamine
- methylphenidate
Initial criteria
- Diagnosis of narcolepsy is confirmed by a sleep lab evaluation
- Member is 7 years of age or older
- If member age ≥ 7 years and < 18 years, member has experienced an inadequate treatment response or intolerance to at least one central nervous system (CNS) stimulant drug (e.g., amphetamine, dextroamphetamine, methylphenidate) OR has a contraindication to at least one CNS stimulant drug (e.g., amphetamine, dextroamphetamine, methylphenidate)
- If member age ≥ 18 years, member has experienced an inadequate treatment response or intolerance to modafinil or armodafinil OR has a contraindication to both modafinil and armodafinil
- 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 daytime sleepiness with narcolepsy from baseline
Approval duration
12 months