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Drug Info

Does Medicaid cover Quviviq?

Since Quviviq is a controlled substance, state Medicaid programs may enforce certain coverage limits
By | Nov. 14, 2024 Medically reviewed by Scott Dershowitz, LMSW, CMC
A person's hand's holding a clipboard and a stethoscope, writing MEDICAID on the clipboard: Does Medicaid cover Quviviq?

Key takeaways

  • Quviviq (daridorexant) is a brand-name medication that helps with sleep disorders, such as insomnia (trouble falling or staying asleep). 

  • Without Medicaid, insurance, or discounts, a 30-day supply of Quviviq 50 mg costs about $633.

  • Although Medicaid may cover Quviviq, there are ways to save without coverage.

In this article:

Getting a good night’s sleep is essential for your overall health and well-being. Unfortunately, getting restful sleep can be challenging for those dealing with chronic insomnia, however. Quviviq is a brand-name medication used once a day to treat insomnia. In a class of drugs called dual orexin receptor antagonists (DORAs), Quviviq works by regulating the sleep-wake cycle, helping people fall asleep faster and stay asleep longer.

Medicaid is administered on the state level, so rules and coverage details depend entirely on which state you live in. Since Quviviq is labeled as a controlled substance, Medicaid may not cover it in the same way it would cover other drugs with less potential for misuse. Although Medicaid may cover Quiviviq, there are certain details you should be aware of if you’re trying to determine how much you will be expected to pay for it.  

Does Medicaid cover Quviviq?

Medicaid may cover Quviviq, but the coverage varies by state. Medicaid is a state-run program, so each state has a list of approved medicines called a preferred drug list or a formulary. It states not only whether a medication is a preferred or nonpreferred drug, but also what tier it is on and whether there are additional requirements that need to be met for coverage. In some states, Medicaid might fully cover the cost of Quviviq if it’s deemed medically necessary. 

Factors influencing Medicaid coverage for Quviviq

If your state’s Medicaid program covers Quviviq, you may need to contend with several restrictions. These can include:

  • Prior authorization: In some cases, Medicaid might require a special healthcare provider’s request, called prior authorization, before it covers Quviviq. This means your healthcare provider must submit a formal request to Medicaid explaining why Quviviq is necessary for your treatment.  
  • Step therapy: Some states may require you to try other similar medications before approving Quviviq. This process, called step therapy, involves trying less expensive or more established treatments before moving to Quviviq.
  • Quantity limits: Medicaid may cover only a specific amount of medication per month. 

For example, the Medicaid Pharmacy Program Preferred Drug List for New York lists Quviviq as a nonpreferred drug, meaning it will cost more than preferred drugs. It also has a 90-day coverage limit. 

Since coverage varies so widely, it’s best to contact your local Medicaid office to determine your amount of coverage and any other requirements that need to be met. Your healthcare provider or pharmacist can help with coverage questions as well.

How much does Quviviq cost?

The average retail cost of Quviq without insurance is about $633 for 30, 50 mg tablets. Prices fluctuate, however, and they can vary significantly by pharmacy. 

How to get Quviviq with Medicaid

The process of getting a sleep aid like Quviviq with Medicaid may not be the same as it would be for other medications. Here’s what you may expect: 

  1. Consult Your healthcare provider. They may want you to try other medications with less potential for dependence first. Or they may recommend lifestyle adjustments, like cutting out certain foods from your diet or going to bed sooner. If those methods fail, they may write you a prescription. 
  2. Check your Medicaid coverage. Verify whether your state’s Medicaid program covers Quviviq. You can do this by visiting your state’s Medicaid website, contacting your local Medicaid office, or asking your pharmacist. If it doesn’t cover Quviviq, or if the copay is too high, you may want to talk to your healthcare provider about Quviviq alternatives, such as Ambien or Belsomra.
  3. Wait for prior authorization. If your state Medicaid program requires prior authorization for Quviviq, you may have to wait longer than you’d have to wait for other medications. If required, your healthcare provider will submit a prior authorization request to Medicaid. This request must demonstrate that Quviviq is medically necessary for you.
  4. Fill your prescription. Once you’ve received approval from Medicaid, you can let your healthcare provider know which pharmacy you want them to send your prescription to.  

Costs of Quviviq with Medicaid

Medicaid generally helps reduce the cost of medications, but you may still have some of your expenses. These can include:

  • Copays: Some states require a small fee for prescription medications. Depending on your state’s rules, this copayment can range from less than $1 to $15, sometimes more.
  • Coinsurance: In some cases, you might need to pay a percentage of the medication’s cost, known as coinsurance. The amount is based on your state’s Medicaid guidelines.

Ways to get discounts on Quviviq without Medicaid

If you don’t have Medicaid or if your state doesn’t cover Quviviq, there are other ways to save on the medication, including:

  • The SingleCare prescription discount card: SingleCare can help you save on Quviviq at participating pharmacies across the country. With a SingleCare coupon, you can pay $488 instead of $633 for a one-month supply of Quviviq. You can use SingleCare coupons if you’re a Medicaid beneficiary, but you can’t combine SingleCare savings with Medicaid.
  • Generic alternatives: While Quviviq doesn’t have a generic version yet, your healthcare provider might know of other similar medications that have more affordable generic alternatives. It’s worth asking your local pharmacy if they have any available discounts.
  • Medicare and Medicare Extra Help: If you have both Medicare and Medicaid, you are considered dually eligible, meaning you can use Medicaid to pay for certain things that Medicare won’t. This may or may not apply to prescriptions. You may qualify for the Part D Low Income Subsidy (LIS) program, also known as Extra Help, if you find it difficult to afford Quviviq with Medicare.

RELATED: How to save on Quviviq

By taking these steps, you can make Quviviq more affordable and access the treatment you need to improve your sleep and overall well-being.

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