The Cost Problem: Why Your Patients Need Help Affording Belsomra

Belsomra (Suvorexant) remains a brand-only medication in 2026, with no generic alternative on the horizon until patents expire between 2029 and 2033. The cash price for a 30-day supply runs $450–$550 regardless of tablet strength (5 mg, 10 mg, 15 mg, or 20 mg). For many patients, this creates a significant barrier to adherence — or prevents them from starting treatment altogether.

As prescribers, we can play a critical role in connecting patients with savings programs and navigating insurance hurdles. This guide consolidates the most effective cost-reduction strategies available for Belsomra in 2026, organized by patient insurance status.

Commercially Insured Patients: Merck Savings Card

Merck offers the Belsomra Savings Card, which is the single most impactful cost-reduction tool for commercially insured patients.

Key Details

• Eligible patients may pay as little as $0 copay per prescription fill
• Available at activatethecard.com/8193
• Savings are subject to a maximum benefit per prescription and per year (terms may change annually)
• Works with most commercial insurance plans

Eligibility Requirements

• Patient must have commercial (private) insurance that covers Belsomra
• Not valid for patients on Medicare, Medicaid, Tricare, VA benefits, or other government-funded insurance programs
• Patient must be 18 or older

How to Use It in Your Practice

• Keep printed or digital information about the savings card available at your front desk or in exam rooms
• Mention it proactively when prescribing Belsomra — many patients won't know it exists
• Direct patients to the enrollment website or have your staff assist with enrollment
• Note that the card works at most retail pharmacies nationwide

Uninsured and Underinsured Patients: Merck Patient Assistance Program

For patients who lack adequate insurance coverage, the Merck Patient Assistance Program (Merck Helps) can provide Belsomra at no cost.

Key Details

• Provides Belsomra free of charge to eligible patients
• Apply at merckhelps.com/BELSOMRA
• Income-based eligibility (typically household income at or below 400% of the Federal Poverty Level, though thresholds may vary)
• Requires provider involvement — a healthcare provider must complete part of the application

Provider's Role in the Application Process

1. Complete the prescriber section of the Merck Helps application
2. Provide a valid prescription for Belsomra
3. Attest that the patient has a medical need for the medication
4. Submit along with the patient's portion of the application

Processing typically takes 2–4 weeks. Consider prescribing a short-term alternative or providing samples while the application is pending.

Medicare and Government-Insured Patients

Patients on Medicare, Medicaid, Tricare, and VA benefits are not eligible for the Merck Savings Card. However, several pathways can help reduce costs:

Medicare Part D Coverage

• Many Medicare Part D plans cover Belsomra, typically on Tier 3 (preferred brand) or specialty tier
• Copays vary widely — from $40–$100+ per month depending on the plan
• Patients in the coverage gap ("donut hole") may pay 25% coinsurance on brand-name drugs
• Patients who reach catastrophic coverage pay significantly less

Medicare Extra Help (Low-Income Subsidy)

Patients with limited income and resources may qualify for the Extra Help program, which can significantly reduce or eliminate Part D copays. Encourage eligible patients to apply through the Social Security Administration.

State Pharmaceutical Assistance Programs (SPAPs)

Many states offer supplemental programs that help Medicare beneficiaries with prescription drug costs. Check your state's SPAP availability for patients who need additional support.

Prior Authorization and Step Therapy Navigation

One of the most common barriers to Belsomra access is insurance-mandated prior authorization (PA) and step therapy requirements. Most commercial and Medicare plans require documentation that the patient has tried and failed on generic alternatives before approving Belsomra.

Streamlining the PA Process

• Document previous trials thoroughly: Include specific generic sleep aids tried (zolpidem, eszopiclone, etc.), duration of use, and reasons for discontinuation (lack of efficacy, adverse effects, contraindications)
• Use diagnosis codes strategically: Ensure the PA request includes appropriate ICD-10 codes for insomnia (G47.00 for unspecified, G47.01 for sleep onset, G47.09 for other)
• Note contraindications: If the patient has contraindications to GABA-based sleep aids (history of complex sleep behaviors, substance use disorder, etc.), document this clearly
• Appeal denials promptly: Most initial PA denials can be overturned on appeal with additional clinical documentation

Step Therapy Tips

Most plans require failure of at least one generic alternative. The fastest path through step therapy:

1. Prescribe generic zolpidem or eszopiclone first (if clinically appropriate)
2. Document the trial period (typically 2–4 weeks is sufficient for most plans)
3. Record specific reasons for failure — efficacy, side effects, or patient-specific factors
4. Submit the PA request with complete trial documentation

Pharmacy-Level Cost Reduction Strategies

Coupon Aggregators and Discount Cards

While manufacturer programs are the most impactful, third-party discount cards can sometimes reduce the cash price for uninsured patients. Options include:

• GoodRx
• SingleCare
• RxSaver
• Optum Perks

Savings vary significantly by pharmacy, and for a $450–$550 brand-name drug, discounts may be modest. However, it's worth checking — some patients have reported savings of $50–$100 through these programs.

Mail-Order Pharmacy

Many insurance plans offer lower copays for 90-day mail-order supplies. For patients on stable Belsomra therapy, switching to mail-order can reduce per-month costs and improve adherence by eliminating monthly pharmacy trips.

Specialty and Independent Pharmacies

Some independent pharmacies negotiate better prices on brand-name medications. It may be worth directing patients to check pricing at multiple pharmacy types.

When to Consider Alternatives

For patients where cost remains prohibitive despite all available savings programs, consider whether an alternative therapy might be appropriate:

• Other DORAs: Dayvigo (Lemborexant) and Quviviq (Daridorexant) are in the same class but may have different insurance coverage or pricing. Check the patient's formulary.
• Generic options: Zolpidem ($10–$30/month) and eszopiclone ($15–$40/month) remain effective first-line options for many patients, though they have different mechanisms and side effect profiles.
• Non-pharmacologic approaches: Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended as first-line treatment by the American Academy of Sleep Medicine and can be used alone or in combination with medication.

For a clinical comparison of alternatives, see our provider resource on what prescribers need to know about the Belsomra shortage in 2026.

Helping Patients Find Belsomra in Stock

Cost isn't the only barrier — availability can be a challenge too. As a brand-only medication, Belsomra isn't stocked at every pharmacy. When patients report difficulty filling their prescription, direct them to MedFinder for Providers to help locate pharmacies with Belsomra in stock.

For a comprehensive guide to pharmacy-level availability strategies, see our article on how to help your patients find Belsomra in stock.

Building a Practice Workflow for Belsomra Cost Navigation

Consider implementing a simple workflow in your practice:

1. At prescribing: Check patient's insurance formulary for Belsomra coverage and tier status
2. For commercially insured patients: Provide Merck Savings Card information (activatethecard.com/8193)
3. For uninsured/underinsured patients: Initiate Merck Helps application (merckhelps.com/BELSOMRA)
4. For Medicare patients: Review Part D coverage, assist with Extra Help application if eligible
5. If PA required: Submit with complete documentation of prior generic trials and clinical rationale
6. At follow-up: Confirm patient was able to fill the prescription and address any cost or access barriers

Training your support staff to handle steps 2–4 can significantly reduce provider time while improving patient outcomes.

Key Takeaways for Providers

• Belsomra's cash price of $450–$550/month is a major adherence barrier
• The Merck Savings Card (commercial insurance) and Merck Helps (uninsured/underinsured) are the two most impactful programs
• Government-insured patients need alternative pathways: Part D optimization, Extra Help, SPAPs
• Thorough prior authorization documentation — especially documenting generic trial failures — is essential
• Direct patients to MedFinder for Providers for real-time pharmacy availability
• No generic Suvorexant is expected until 2029–2033

By proactively addressing cost at the point of prescribing, we can improve treatment adherence and ensure patients who need Belsomra can actually access it.