Zolpidem Tartrate capsules — CareFirst (Caremark)

Initial criteria

• Authorization may be granted when the requested drug is being prescribed for insomnia when the following criterion is met:
• • 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

• Authorization may be granted when the requested drug is being prescribed for insomnia and ALL of the following criteria are met:
• • 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 therapy: 6 months; Continuation of therapy: 12 months