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Dayvigo™ (lemborexant) (Revised)
Effective date
Jan 1, 2022
Identified
Oct 21, 2026
Replaced. This version was replaced by Dayvigo™ (lemborexant) (Revised) (published Jan 1, 2022).
Summary
This is a historical Humana Medicare Advantage prior authorization policy for Dayvigo (lemborexant) for insomnia treatment, originally effective January 1, 2022, and last revised December 17, 2025. The policy requires members to have documented insomnia diagnosis and prior treatment failure or contraindication to Belsomra (suvorexant) or trazodone before approval; members with narcolepsy are excluded. The billing team should verify current applicability with Humana's online portal, as this document was newly discovered on the analysis date despite its 2022 origin.
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What to do
Action · 4 steps
01Verify current applicability: The medical billing team should confirm with Humana whether this Dayvigo prior authorization policy remains in effect as of the analysis date (2026-10-21), since the source was newly discovered despite originating in 2022.
02Per the policy disclaimer, staff should refer to Humana's current online Medical and Pharmacy Coverage Policies portal (https://dctm.humana.com/Mentor/Web) before processing claims, as printed versions become uncontrolled and may not reflect the most current version.
03For any Dayvigo prior authorization requests for Medicare Advantage members, ensure prior authorization is submitted with documentation of: (1) insomnia diagnosis with sleep onset and/or maintenance difficulties, and (2) prior treatment failure, contraindication, or documented intolerance to Belsomra (suvorexant) or trazodone.
04Flag any requests for members with narcolepsy diagnosis for denial, as this is a stated contraindication and exclusion criterion.
Original notice
Dayvigo™ (lemborexant) (Revised)
mcp.humana.com · Always check the source before changing claims.
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