Provigil — CareFirst (Caremark)
Excessive sleepiness associated with shift work disorder (SWD)
Initial criteria
- The requested drug is being prescribed by, or in consultation with, a sleep specialist.
- A sleep log and actigraphy monitoring have been completed for at least 14 days AND show a disrupted sleep and wake pattern.
- Symptoms have been present for 3 or more months.
Reauthorization criteria
- The patient has achieved or maintained a positive response to treatment from baseline.
- The patient is still a shift-worker.
Approval duration
12 months