Have questions about your insurance coverage?
DAYVIGO® (lemborexant) may be covered by commercial insurance companies, Medicare, and Medicaid. Coverage may vary significantly by insurance company, specific health insurance plan, and patient. Insurance companies can base coverage decisions on formal policies or make decisions on a case-by-case basis. Ask your pharmacist or insurance company whether your insurance will cover DAYVIGO.
TYPES OF INSURANCE
Commercial insurance is provided by nongovernment health plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Many people purchase commercial health insurance through their employer’s health plan, or you can purchase an individual policy directly from commercial insurance providers. The exact coverage you receive depends on the specific policy that you purchase.
Several plans may provide coverage for DAYVIGO. Contact your pharmacist or insurance company to find out if you will have coverage for DAYVIGO.
Commercially insured patients may be eligible for the DAYVIGO Instant Savings Card.
Medicare is a federal health insurance program for people who are 65 years or older, certain younger people with disabilities, and people with end-stage renal disease. Part D covers prescription drugs that you get at a pharmacy and take at home, including DAYVIGO. Your healthcare provider will be able to help you understand how Medicare may cover DAYVIGO.
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Each state sets its own coverage and eligibility rules for Medicaid programs. However, coverage and patient out-of-pocket costs vary from state to state. Your healthcare provider will be able to help you understand how your state Medicaid plan may cover DAYVIGO.
Insurance plans are not affiliated with or offered by Eisai.
DETERMINING YOUR COVERAGEIf you are planning to see your doctor to determine if DAYVIGO is right for you, or if you have recently received a prescription for DAYVIGO, you may want to investigate your health insurance coverage for this type of drug prior to visiting the pharmacy.
Before speaking with your insurance company, be sure to have your policy number or employer’s plan number handy. When speaking with the claims representative, here are some important questions to ask:
- Is prior authorization required for DAYVIGO?
- Are there any insomnia treatments I’m required to have tried prior to authorizing coverage of DAYVIGO?
- Will you require any documentation of treatments that I’ve tried but failed?
- If approved, what is the patient out-of-pocket cost for the drug?
WHAT CAN YOU DO IF YOU RECEIVE A DENIAL OF COVERAGE?
“PRIOR AUTHORIZATION REQUIRED” CATEGORIZATION
Prior authorization is a requirement for your physician to obtain approval from your health insurance plan prior to prescribing DAYVIGO. Speak to your healthcare provider for additional resources to address any prior authorization requirements.
“STEP THERAPY” CATEGORIZATION
Your insurer may ask if you have tried and failed another insomnia therapy before approving coverage for DAYVIGO. In this case, it is important to include documentation of any previous treatments in your appeal letter. Ask your healthcare provider about documentation needs to address step therapy requirements.
APPEALING A DENIAL
If you called your insurance company and were told that DAYVIGO is not covered under your plan, or if you tried to fill a prescription for DAYVIGO and learned that the drug is not covered, this is called a denial of coverage or denial of claim. You may have the right to appeal this decision and request a detailed explanation in writing as to why you were denied.
Eisai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payer, plan, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. For additional information, customers should consult with their payers for all relevant coding, reimbursement, and coverage requirements. It is the sole responsibility of the provider to select the proper code and ensure the accuracy of all claims used in seeking reimbursement. All services must be medically appropriate and properly supported in the patient medical record.
WHAT IS DAYVIGO?
DAYVIGO is a prescription medicine for adults age 18 years and older who have trouble falling or staying asleep (insomnia).
IMPORTANT SAFETY INFORMATION
DAYVIGO may cause serious side effects including:
decreased awareness and alertness. The morning after you take DAYVIGO, your ability to drive safely and think clearly may be decreased. You may also have sleepiness during the day. Do not take more DAYVIGO than prescribed. Do not take DAYVIGO unless you are able to stay in bed for a full night (at least 7 hours) before you must be active again. Take DAYVIGO right before going to bed.
Do not take DAYVIGO if you fall asleep often at unexpected times (narcolepsy).
DAYVIGO is a federally controlled substance because it can be abused or cause dependence.
Before taking DAYVIGO, tell your healthcare provider about all of your medical conditions, including if you:
have a history of depression, mental illness, or suicidal thoughts; drug or alcohol abuse or addiction; a sudden onset of muscle weakness (cataplexy); daytime sleepiness
have lung problems or breathing problems
have liver problems
are pregnant or plan to become pregnant
are breastfeeding or plan to breastfeed. DAYVIGO passes into your breastmilk
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
Taking DAYVIGO with certain other medicines can cause serious side effects. DAYVIGO may affect the way other medicines work and other medicines may affect the way DAYVIGO works.
Do not take DAYVIGO with other medicines that can make you sleepy unless your healthcare provider tells you to.
What should I avoid while taking DAYVIGO?
Do not drink alcohol while taking DAYVIGO. It can increase your chances of getting serious side effects.
Do not drive, operate heavy machinery, do anything dangerous, or other activities that require clear thinking if you take DAYVIGO and have had less than a full night of sleep (at least 7 hours) or if you have taken more DAYVIGO than prescribed by your healthcare provider.
You may still feel drowsy the next day after taking DAYVIGO. Do not drive or do other dangerous activities until you feel fully awake.
DAYVIGO may cause serious side effects, including:
temporary inability to move or talk (sleep paralysis) for up to several minutes while you are going to sleep or waking up
temporary weakness in your legs that can happen during the day or at night
complex sleep behaviors such as sleep-walking, sleep-driving, preparing and eating food, making phone calls, having sex or doing other activities while not fully awake that you may not remember the next morning.
worsening depression and suicidal thoughts have happened during treatment with DAYVIGO.
The most common side effect of DAYVIGO is sleepiness.
These are not all of the possible side effects of DAYVIGO. Call your doctor for medical advice and if you have any new or worsening side effects.
Please read the accompanying Medication Guide for DAYVIGO and discuss it with your doctor