Step Therapy / Prior Authorization Criteria for Ambien CR (zolpidem extended release), Lunesta (eszopiclone), Rozerem (ramelteon), and Sonata (zaleplon)
TRICARE will NOT cover Ambien CR, Lunesta, Rozerem, or Sonata for new patients—defined as patients who have not filled at least one prescription for a newer sedative hypnotic in the previous 180 days at any DoD Pharmacy point of service—UNLESS the patient meets one of the following criteria:
1. The patient has tried zolpidem IR (Ambien) and had an inadequate response.
2. The patient has tried zolpidem IR (Ambien) and was unable to tolerate it due to adverse effects.
3. Treatment with zolpidem IR (Ambien) is contraindicated for this patient.
4. Rozerem, which is a non-controlled drug with a mechanism of action different from other newer sedative hypnotics, is the most clinically suitable choice for the patient due to its apparent lack of abuse potential.
Criteria approved through the Uniform Formulary decision-making process (February 2007).
Comment: At a time when more service members than ever are suffering from mental health problems such as PTSD, Tricare has made it more difficult to obtain medications useful for the treatment of insomnia. Now only the generic form of Ambien (zolpidem) is available without prior authorization. This move will undoubtedly save millions in pharmacy costs. What impact will it have on our Soldiers, Sailors and Marines? Will decreased access to medication increase disability and personnel loss in the military or will it bring in line "undisciplined" doctors?
Reference: http://www.tricare.mil/pharmacy/SED-1_criteria.cfm
