Wakix (pitolisant) — United Healthcare

Narcolepsy without Cataplexy (Narcolepsy Type 2)

Preferred products

Submission of medical records documenting a diagnosis of narcolepsy with both of the following: (a) patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months AND (b) mean sleep latency ≤ 8 minutes and two or more sleep onset REM periods (SOREMPs) found on a MSLT performed according to standard techniques following a normal overnight polysomnogram; a SOREMP within 15 minutes of sleep onset on the preceding polysomnogram may replace one on the MSLT.
Physician attestation that other causes of sleepiness have been ruled out or treated (including but not limited to obstructive sleep apnea, insufficient sleep syndrome, shift work, effects of substances or medications or their withdrawal, sleep phase disorder, or other sleep disorders).
One of the following: (a) history of failure, contraindication, or intolerance to all of the following: armodafinil (Nuvigil) or modafinil (Provigil), an amphetamine (e.g., amphetamine, dextroamphetamine) or methylphenidate-based stimulant, and Sunosi OR (b) history of or potential for a substance abuse disorder.
Prescribed by or in consultation with a neurologist, psychiatrist, pulmonologist, or sleep medicine specialist.

Reduction in symptoms of excessive daytime sleepiness associated with Wakix therapy.

12 months