Hetlioz (tasimelteon capsules) — Cigna

Initial criteria

• Patient is ≥ 18 years of age
• Patient is totally blind with no perception of light
• Diagnosis of Non-24 is confirmed by ONE of the following: (a) assessment of at least one physiologic circadian phase marker OR (b) if assessment cannot be done, diagnosis confirmed by actigraphy performed for ≥ 1 week plus evaluation of sleep logs recorded for ≥ 1 month
• Patient has received at least 6 months of continuous therapy with melatonin under the guidance of a physician who specializes in the treatment of sleep disorders AND had inadequate efficacy with melatonin therapy
• Medication is prescribed by or in consultation with a physician who specializes in the treatment of sleep disorders

Reauthorization criteria

• Patient is ≥ 18 years of age
• Patient is totally blind with no perception of light
• Patient has received at least 6 months of continuous therapy with melatonin under the guidance of a physician who specializes in the treatment of sleep disorders AND had inadequate efficacy with melatonin therapy
• Patient has received at least 6 months of continuous therapy with tasimelteon capsules under the guidance of a physician who specializes in the treatment of sleep disorders
• According to the prescriber, patient has achieved adequate results with tasimelteon capsules therapy

Approval duration

6 months initial; 1 year renewal