Sunosi (solriamfetol) — Highmark
obstructive sleep apnea/hypopnea syndrome (OSAHS)
Preferred products
- generic modafinil
- generic armodafinil
Initial criteria
- age ≥ 18 years
- diagnosis of OSAHS (ICD-10: G47.33)
- meets one of the following: (a) currently receiving and compliant with positive airway pressure (PAP) OR (b) has therapeutic failure, intolerance, or contraindication to PAP AND currently using and compliant with a custom, titratable oral appliance
- persistent daytime sleepiness despite adequate OSA treatment AND prescriber attests alternative causes of daytime sleepiness have been excluded
- therapeutic failure, contraindication, or intolerance to both of the following: generic modafinil AND generic armodafinil
Reauthorization criteria
- meets one of the following: (a) currently receiving and compliant with PAP OR (b) has therapeutic failure, intolerance, or contraindication to PAP AND currently using and compliant with a custom, titratable oral appliance
- prescriber attests member has experienced improvement in daytime sleepiness
Approval duration
12 months