Medicare AdvantagePrior AuthMedium impact
Sunosi® (solriamfetol) (Revised)
Humana·Sleep Medicine, Neurology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Sunosi (solriamfetol) tablets effective January 1, 2025. The policy establishes strict criteria for coverage of this sleep disorder medication, requiring documented sleep testing, failed trials of other medications, and specific diagnostic criteria for both narcolepsy and obstructive sleep apnea.
Action Required
By January 1, 2025: Billing and authorization teams must update prior authorization workflows for Sunosi (solriamfetol) prescriptions for Humana Medicare Advantage members. Ensure providers document sleep testing results, previous medication trials (CNS stimulants, modafinil/armodafinil), and meet specific diagnostic criteria before submitting authorization requests. Update EMR templates to capture required documentation including ICSD-3 or DSM-5 criteria compliance and CPAP therapy compliance for OSA patients.