Edluar (zolpidem) — Point32Health
insomnia characterized by difficulties with sleep onset and/or sleep maintenance
Preferred products
- eszopiclone
- zaleplon
- zolpidem tartrate
- ramelteon
Initial criteria
- The patient has had a trial of a Step-1 or Step-2 medication within the previous 180 days as evidenced by a previous paid claim under the prescription benefit administered by the plan
- OR the patient has had previous trial of a Step-1 or Step-2 medication as evidenced by physician documented use
- OR the patient has a physician documented contraindication or intolerance to all Step-1 medications
- Note: The plan may cover Step-2 medications if a patient has received a non-formulary medication containing the same therapeutic ingredient as a lower step agent as evidenced by physician documented use