modafinil — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed by, or in consultation with, a sleep specialist.
• The diagnosis has been confirmed by polysomnography or home sleep apnea test (HSAT) with a technically adequate device.
• The patient has been receiving treatment for the underlying airway obstruction (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BIPAP]) for at least one month.
• The patient will continue to use CPAP or BIPAP after the requested drug is started.

Reauthorization criteria

• The patient has achieved or maintained a positive response to treatment from baseline.
• The patient is compliant with using continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP).

Approval duration

12 months