Sedative Hypnotics Step Therapy Program

A step therapy program is being implemented for sedative hypnotics effective September 15, 2007.

Sedative hypnotics include generic Ambien (zolpidem tartrate), Ambien, Ambien CR, Sonata, Lunesta, and Rozerem.

Program Details

Here are the steps to follow for sedative hypnotics to be a covered benefit for your patients.

• First prescribe generic Ambien (zolpidem tartrate)
• If you determine generic Ambien is not effective, you can prescribe one of the other sedative hypnotics

When following step therapy guidelines, no prior authorization (PA) is necessary. The prescription for the next level of sedative hypnotic will automatically approve if there is prior history in the claims system of generic Ambien.

If you believe it is medically appropriate for you patient to “skip” steps, you will need to submit a prior authorization request and receive approval for the drug to be covered.

Patients Taking a Sedative Hypnotic Prior to September 15, 2007

• Patients must try and fail generic Ambien or Ambien before coverage is available for other sedative hypnotics
• If there is claims history for generic Ambien or Ambien in the Wellmark system, the prescription for the alternative sedative hypnotic will be approved without obtaining a prior authorization
• If there is no documentation in the Wellmark system, you must contact Wellmark to request approval for the alternative sedative hypnotic

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