Lumryz (sodium oxybate) (Revised)

By July 24, 2024 (or immediately upon discovery): (1) Billing and prior authorization teams must update Humana submission requirements to enforce the two distinct approval pathways for narcolepsy with cataplexy versus excessive daytime sleepiness—do NOT submit single requests covering both indications. (2) For cataplexy cases: Require documentation of prior treatment/intolerance/contraindication to Wakix (pitolisant) before submitting PA requests. (3) For EDS cases: Require documented sleep testing (polysomnography or MSLT) AND documented prior treatment/failure with at least one CNS stimulant (methylphenidate, amphetamine salts, dextroamphetamine) OR modafinil/armodafinil AND Wakix failure. (4) Add system validation to prevent approval if member has concurrent Xyrem, Xywav, Wakix, or Sunosi claims. (5) Set initial approval alerts for 3-month renewal triggers and renewal approval alerts for 6-month intervals. (6) Update provider education materials and encounter forms to include sleep testing documentation requirements and Wakix failure documentation requirements. (7) Train front-desk and billing staff to collect these documentation items upfront to prevent claim denials. Failure to obtain proper prior authorization or submit required documentation will result in claim denials by Humana.