Summary
This is a historical Humana Medicare Advantage prior authorization policy for Dayvigo™ (lemborexant) for insomnia treatment, originally effective January 1, 2022, with a revision dated October 28, 2026. The policy requires members to have documented insomnia and prior treatment failure or intolerance to Belsomra (suvorexant) or trazodone before approval; members with narcolepsy are excluded. This document was newly discovered on the analysis date but represents an already-effective policy; the billing team should verify current applicability with Humana's online policy portal rather than treating this discovery as a new deadline.
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What to do
Action · 3 steps
01Already effective 2022-01-01: Verify whether this Humana Medicare Advantage prior authorization policy for Dayvigo™ (lemborexant) is currently active and applicable to the practice's patient population.
02Before submitting claims for Dayvigo™, billing team should (1) confirm the member has a documented diagnosis of insomnia with sleep onset and/or maintenance difficulties, (2) verify prior treatment, contraindication, or intolerance to Belsomra (suvorexant) or trazodone tablet, and (3) confirm the member does not have narcolepsy.
03Submit prior authorization requests through Humana's system and refer to the online policy portal at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a607a16 to confirm this is the current version before utilization, as Humana's documents are updated regularly and printed copies become uncontrolled.
Original notice
Dayvigo™ (lemborexant) (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
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