Coverage for DAYVIGO™ is primarily through a patient’s pharmacy benefit. Coverage and reimbursement may vary significantly by payor, plan, and patient. Payors can base coverage decisions on formal policies or make decisions on a case-by-case basis.
Commercial insurance companies include organizations such as health maintenance organization (HMO) plans, managed care organizations, indemnity plans and others. Several plans may provide coverage for DAYVIGO. However, specific coverage requirements and limits depend on a patient’s benefits and will vary based on your plan type and healthcare provider. Contact your healthcare provider to understand if you will have coverage for DAYVIGO.
Commercially insured patients may be eligible for the Savings Card Program for DAYVIGO.
To learn more about this program, click here.
Medicare is the federal health insurance program for people who are 65 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 its Medicaid program. DAYVIGO is eligible for coverage under most state Medicaid programs. However, coverage and patient out-of-pocket costs will vary from state to state. Your healthcare provider will be able to help you understand how your state Medicaid plan will cover DAYVIGO.
Insurance plans are not affiliated with or offered by Eisai.
If you are planning to see your doctor to determine if DAYVIGO is appropriate 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.
Below is the information you will first need to gather to determine your coverage for DAYVIGO
Insurance company’s name and phone/fax number
Policy number or employer’s plan number
Name and date of birth of the primary insured person
Insurance company website address (Many insurance companies maintain websites that include plan information, such as the preferred drug list and the process for appealing a denial. Sometimes you may be required to sign up to view certain areas of the website. If you require assistance, you may always call your insurance company’s member services telephone number.)
Below are important questions to ask your insurance company’s claims representative when researching the coverage provided by your plan for DAYVIGO
Is Prior Authorization(PA) required for DAYVIGO?
Are there any insomnia treatments I am required to have tried prior to authorizing coverage of DAYVIGO?
You may be required to provide documentation of treatments you have tried and failed, if applicable.
What is the patient out of pocket costs for the drug, if it is approved?
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 you 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. You may request from your insurer a detailed explanation in writing as to why you were denied. Once you receive the explanation, read it carefully. Denials may be categorized as either “Prior Authorization” or “Step therapy required.”
Prior authorization (PA) is a requirement that your physician obtain approval from your health insurance plan prior to prescribing DAYVIGO to you. Speak to your healthcare provider for additional resources to address any PA requirements.
Your insurer may ask if you have tried and failed at another sleep therapy before trying DAYVIGO. In this case, it is important to include documentation of any previous treatments in your appeal letter. Speak to your healthcare provider to inquire about documentation needs to address “step therapy” requirements.
Eisai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payor, plan, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payors following the receipt of claims. For additional information, customers should consult with their payors 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.
DAYVIGO is a prescription medicine for adults age 18 years and older who have trouble falling or staying asleep (insomnia).
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.
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
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 Medication Guide for DAYVIGO and discuss it with your doctor
The information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare professional. All decisions regarding patient care must be made with a healthcare professional, considering the unique characteristics of the patient.
This site is intended for residents of the United States only. Any products discussed herein may have different product labeling in different countries.
DAYVIGO™ is a trademark of Eisai R&D Management Co., Ltd. and is licensed to Eisai Inc.©2020 Eisai Inc.