Health Net
armodafinil (armodafinil)
Drugs for the Nervous System : Drugs for Sleep Disorder
  • Step Therapy Applies
  • Prior Authorization: EDS due to OSA:
    Documented Diagnosis: Yes
    Age Requirement: >= 17
    Duration: 1 plan year
    Reauthorization Required: Yes

  • EDS due to OSA:
    Age Requirement: >= 17
    Duration: 1 plan year
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year

    Neurology: Narcolepsy:
    Age Requirement: >= 17
    Duration: 1 plan year
    Specialist Required: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Neurologist;Sleep Disorders Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    Number of Episodes of Cataplexy Required in Policy: N/A
    Documented Duration of Daily EDS Occurrences: N/A
    Other causes of sleepiness have been ruled out.: No
    Patient must have CSF hypocretin 1 deficiency: No
    Patient Does Not Have a Deficiency of Succinic Semialdehyde Dehydrogenase: No
    Patient Does Not Have a History of Substance Abuse: No
    Patient is Not Using a Sedative Hypnotic: No
    Patient Will Not Be Using with Alcohol: No
    Documentation Requiring Patient to be Enrolled in REMS Success Program: No
    Documentation of prescriber enrollment in REMS program: No
    Prescriber Must Check Patient's Drug History on Controlled Substance Database: No
    Documented Time Period or Frequency of Time That the Precriber Must Regularly See the Patient: N/A
    Diagnosis Type(s): Unspecified
    Documented Diagnosis: Yes
    Patient has >1 Cataplexy Episodes: No
    Documented Daily EDS occurrences >= 3 months: No
    MSLT <8min with evidence of 2 SOREMP's: No
    MSLT with evidence of >= 1 SOREMP's and SOREMP, 15 min from preceeding night PSG: No
    CSF Hypocretin-1 Deficiency: No
    Prescriber Must See Patient Every 3 Months: No