Sunosi — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• Patient has been evaluated using polysomnography and multiple sleep latency test (MSLT)
• Diagnosis of narcolepsy has been confirmed, according to the prescriber
• Sunosi is prescribed by or in consultation with a sleep disorder specialist, psychiatrist, or neurologist
• Patient has tried ONE of the following: central nervous system (CNS) stimulant, generic modafinil, or generic armodafinil

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

1 year