modafinil — CareFirst (Caremark)

Idiopathic hypersomnia

Initial criteria

The requested drug is being prescribed by, or in consultation with, a sleep specialist.
The patient has experienced the presence of daytime lapses into sleep or daily irrepressible periods of need to sleep for at least 3 months.
Insufficient sleep syndrome has been ruled out such as by lack of improvement of sleepiness after an adequate trial of increased nocturnal time in bed, preferably confirmed by at least a week of sleep log with wrist actigraphy.
A multiple sleep latency test (MSLT) documented fewer than two sleep onset rapid eye movement periods (SOREMPs) or no SOREMPs if the rapid eye movement (REM) latency on the preceding polysomnogram was less than or equal to 15 minutes.
Sleep lab evaluation showed at least ONE of the following: mean sleep latency on MSLT of less than or equal to 8 minutes, total 24-hour sleep time of greater than or equal to 660 minutes on 24-hour polysomnographic monitoring after correcting any chronic sleep deprivation or by wrist actigraphy in association with a sleep log and averaged over at least 7 days of unrestricted sleep.
The patient does NOT have cataplexy.
Hypersomnolence or MSLT results are not better explained by another sleep disorder, other medical or psychiatric disorder, or use of drugs or medications.

The patient has achieved or maintained a positive response to treatment from baseline.

12 months