Xywav — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has been evaluated using polysomnography and a multiple sleep latency test
• Results of the polysomnography and multiple sleep latency test are congruent with a diagnosis of idiopathic hypersomnia, according to the prescriber
• The medication has been prescribed by a sleep specialist physician or a neurologist
• Patient has tried at least one of modafinil, armodafinil, or methylphenidate

Approval duration

1 year