Is Quviviq covered by Blue Cross Blue Shield?

In this article:

• Does Blue Cross Blue Shield cover Quviviq?
• How much does Quviviq cost?
• Cost of Quviviq with BCBS
• How to check whether your plan covers Quviviq
• How to save on Quviviq

In this article

• Does Blue Cross Blue Shield cover Quviviq?
• How much does Quviviq cost?
• Cost of Quviviq with BCBS
• How to check whether your plan covers Quviviq
• How to save on Quviviq

Quviviq (daridorexant) is a brand-name medication approved by the Food and Drug Administration (FDA) to treat insomnia (difficulty with sleep onset or sleep maintenance) in adults. “Quviviq is a medication that is a dual orexin receptor antagonist (DORA)—a fancy way of saying that this medication blocks orexin, a substance found in the brain that is involved in wakefulness and arousal,” says Brittney Jones, Psy.D., a licensed clinical psychologist, a board-certified insomnia specialist, and founder of Today’s Psychologist.

According to Dr. Jones, Quviviq may not be covered by your insurance in some instances. If it is covered, you may be required to get prior authorization. Also known as precertification or prior approval, prior authorization is approval from your health plan that may be required before you get a medical service or fill a prescription for them to be covered by your plan.

“It is important to work alongside your prescribing physician to know whether this medication is appropriate and to discuss the prior authorization process,” Dr. Jones says.

Does Blue Cross Blue Shield cover Quviviq?

Insurance coverage can be tricky, as some health plans may cover a certain medical service or prescription medication, and others may not—even if they’re under the same company. The BCBS Association is a national federation of 36 independent, community-based, and locally operated BCBS companies, each with its own policies for its insurers.

With that being said, BCBS may or may not cover Quviviq. “In most cases, Quviviq is rarely covered by insurance,” says Sisse Marie, a psychotherapist at Neurogan Health. “It all depends on how it’s treated by insurance plans. She says that, in some cases, it’s a preferred drug, while in other cases, it requires step therapy—which is when the patient must try other drugs first. They may also impose quantity limits, also called dispensing limits. For example, Blue Cross Blue Shield of Illinois imposes a limit of 30 tablets every 30 days.

If your healthcare provider believes Quviviq is the most effective medication for your insomnia, they may be able to ask for an exception. If this gets approved, you can expect to pay a higher tier cost for the prescription drug. 

RELATED: Is Quviviq covered by Medicare? │Does Medicaid cover Quviviq?

How much does Quviviq cost?

If your insurance doesn’t cover Quviviq, you can expect to pay an average retail price of $633 for a 30-day supply of 50 milligrams (mg) of Quviviq tablets. Keep in mind that drug prices fluctuate and vary by pharmacy, however. 

How much does Quviviq cost with Blue Cross Blue Shield?

The price of Quiviq with BCBS depends on which tier it’s on in the plan’s formulary—a list of prescription drugs covered by a health insurance or prescription drug plan. The higher the tier, the higher the cost. 

Although Quviviq may not be covered by many BCBS plans, some plans will cover other alternative sleep agents. BlueCross BlueShield Minnesota, for example, approves the following treatments for insomnia:

• Ambien
• Ambien CR
• Belsomra
• Edluar
• Intermezzo
• Lunesta
• Rozerem
• Silenor
• Sonata
• Zolpimist

If your BCBS health insurance plan covers other insomnia medications, it may be worth discussing with your healthcare provider whether you can be prescribed one of the approved medications or generic drugs. 

RELATED: What is the best medication for treating anxiety and insomnia?

How to check whether your Blue Cross Blue Shield plan covers Quviviq 

Even if coverage of Quviviq with BCBS seems unlikely, it doesn’t hurt to double-check just to confirm. A good starting point is to look at your plan’s formulary. You can typically find this in the documents they send you after enrolling in your plan or by logging in to your online account and going to “Resources” or “Benefits.” 

Given how lengthy formularies can be, you may need to scroll a bit before you land on Quviviq. If you find that the medication is on a list of excluded medications, you can ask your healthcare provider for assistance.

“If your plan doesn’t cover this medical condition, your healthcare provider can put in a request to cover it to provide the expected help,” Marie says. 

How to save on Quviviq

Fortunately, if you find that your Blue Cross Blue Shield plan doesn’t cover Quviviq, there are ways you can lower your cost. “One of the best ways to save on Quviviq is by choosing SingleCare, which offers massive discounts at different pharmacies,” Marie says. With a Quviviq coupon from SingleCare, you could pay $489 instead of $633 for 30, 50 mg tablets, depending on your choice of pharmacy. You can use the discount whether or not you have insurance. 

To get a Quviviq coupon, search for your preferred pharmacy on the Quviviq coupon page on the SingleCare website. Next, click “Get free coupon,” which will provide a coupon you can save on your phone or print out. Simply show it to your pharmacist to get your discount. 

In addition to this discount card, there are other ways you can save on Quviviq. Ask your pharmacist or healthcare provider about your options. Your healthcare provider may also be able to recommend lifestyle changes and Quiviviq alternatives to help you get the sleep you need.