temazepam — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for insomnia.
• Potential factors contributing to sleep disturbances have been addressed or are currently being addressed (e.g., inappropriate sleep hygiene and sleep environment issues) as well as treatable medical/psychiatric disorders that are co-morbid with insomnia.

Reauthorization criteria

• The requested drug is being prescribed for insomnia.
• The patient has achieved or maintained a positive response to treatment from baseline.
• The patient’s need for continued therapy has been assessed.
• Potential factors contributing to sleep disturbances continue to be addressed (e.g., inappropriate sleep hygiene, sleep environment issues, treatable medical/psychiatric comorbid disorders).

Approval duration

Initial: 6 months; Continuation: 12 months