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Quviviq (daridorexant) (Revised)
Effective date
Jan 1, 2024
Identified
Nov 3, 2026
Previous versions
- Quviviq (daridorexant) (Revised) · effective Jan 1, 2024
- Quviviq (daridorexant) (Revised) · effective Jan 1, 2024
Summary
This is a historical policy document (published 2024-01-01, revised 2026-10-28) describing Humana Medicare Advantage's step-therapy requirement for Quviviq (daridorexant) for insomnia treatment. The policy requires prior authorization and evidence of previous treatment failure or contraindication to Belsomra (suvorexant) or trazodone before approval. This policy has been in effect since January 1, 2024, and remains current as of the analysis date.
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What to do
Action · 5 steps
01Already effective since 2024-01-01: Billing team must obtain prior authorization before claims for Quviviq (daridorexant) are submitted to Humana Medicare Advantage plans.
02Verify that prescribing providers document prior treatment, contraindication, or intolerance to Belsomra (suvorexant) or trazodone in the patient's chart and include this documentation with the prior authorization request.
03Update the practice's prior authorization tracker and charge entry processes to flag Quviviq prescriptions for step-therapy review.
04Tell providers and pharmacy staff that claims without prior authorization demonstrating the required step-therapy criteria will be denied.
05For patients who have already initiated Quviviq without prior auth, monitor for denials and prepare to resubmit with proper clinical documentation if the step-therapy criteria are met.
Original notice
Quviviq (daridorexant) (Revised)
mcp.humana.com · Always check the source before changing claims.