Medicare AdvantagePrior AuthMedium impact
Dayvigo™ (lemborexant) (Revised)
Humana·Psychiatry, Sleep Medicine, Neurology +2 more·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Dayvigo (lemborexant) prior authorization policy, effective January 1, 2022, with the most recent revision dated December 17, 2025. The policy requires prior authorization for this insomnia medication and mandates that members have documented failed treatment, contraindication, or intolerance to Belsomra (suvorexant) or trazodone before approval. The policy explicitly excludes members with narcolepsy from coverage.
Action Required
Before submitting any Dayvigo (lemborexant) claims for Humana Medicare Advantage members: (1) Billing team and providers must verify that members meet BOTH approval criteria—diagnosis of insomnia with sleep onset/maintenance difficulty AND documented prior treatment failure, contraindication, or intolerance to Belsomra (suvorexant) or trazodone; (2) Obtain prior authorization before dispensing or billing; (3) Screen for exclusion criterion—do NOT submit for members with narcolepsy diagnosis; (4) Update claim submission workflows to flag Dayvigo prescriptions for mandatory prior auth review; (5) Ensure provider documentation includes evidence of previous treatment attempts or documented contraindications. Claims submitted without prior authorization or for excluded members (narcolepsy) will be denied.