CommercialPrior AuthMedium impact
Non-Benzodiazepine Hypnotics (Revised)
Humana·Psychiatry, Sleep Medicine, Internal Medicine +1 more·Commercial
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana updated its Non-Benzodiazepine Hypnotics pharmacy coverage policy (effective January 1, 2020, revised June 26, 2024) establishing a step therapy requirement for coverage. Members must have previous treatment within the past 12 months OR intolerance to zolpidem IR AND previous treatment within the past 12 months OR intolerance to either eszopiclone or zaleplon before newer agents (Belsomra, Dayvigo, Quviviq, etc.) are approved. This is a step therapy/prior authorization policy affecting 15 covered hypnotic medications.
Action Required
Immediately: Billing and prior authorization team must verify that Humana step therapy rules are correctly configured in the authorization system for all 15 covered non-benzodiazepine hypnotics (Ambien, Ambien CR, Belsomra, Dayvigo, doxepin tablet, Edluar, Intermezzo, Lunesta, Quviviq, Rozerem, Silenor, zolpidem sublingual, zolpidem capsule, Zolpimist). For any Humana Commercial plan prior authorization requests on these medications: verify that the member has documentation of previous treatment with zolpidem IR within the past 12 months OR documented intolerance to zolpidem IR AND previous treatment with eszopiclone or zaleplon within the past 12 months OR documented intolerance to one of those agents. If criteria are not met, deny the authorization and communicate to the prescriber that step therapy requirements must be satisfied first. Update internal authorization protocols and provider communications to reflect this dual-criteria requirement. Providers should be advised of this policy before submitting requests to avoid claim denials. Note: Policy revision date of June 26, 2024 indicates recent updates—verify the current version at http://apps.humana.com/tad/tad/home.aspx before processing any authorizations.