Wakix — Medical Mutual

Initial criteria

• Patient is age ≥ 6 years
• Patient has been evaluated using polysomnography and a multiple sleep latency test
• Diagnosis of narcolepsy has been confirmed according to the prescriber
• The medication is prescribed by or in consultation with a sleep specialist physician or a neurologist
• If the patient is age ≥ 18 years, then the patient meets ONE of the following: (i) Patient has tried generic modafinil or generic armodafinil (exception if patient has previously tried brand Provigil or Nuvigil); OR (ii) Patient has a history of substance use disorder and a wakefulness-promoting agent that is not a controlled substance is necessary, per the prescriber

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

1 year