Hetlioz capsules — Medica
Non-24-Hour Sleep-Wake Disorder (Non-24) in adults
Preferred products
- generic tasimelteon capsules
Initial criteria
- Patient meets the standard Tasimelteon Products Prior Authorization Policy criteria
- Patient has tried generic tasimelteon capsules [documentation required]
- Patient cannot continue to use generic tasimelteon capsules due to a formulation difference in the inactive ingredient(s) (e.g., difference in dyes, fillers, preservatives) which, per the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]
Approval duration
1 year