Helping Patients Find Belsomra: A Practical Guide for Providers

Prescribing Belsomra (Suvorexant) is straightforward. Getting your patient's prescription filled is often the harder part. As a brand-only dual orexin receptor antagonist (DORA) with a monthly cash price of $450 to $550, Belsomra presents unique challenges at the dispensing level that can disrupt patient care.

This guide offers practical, actionable strategies for providers to help patients navigate Belsomra availability issues and maintain continuity of treatment.

Understanding the Dispensing Challenge

When you prescribe Belsomra, your patients may encounter one or more of the following barriers at the pharmacy:

• Out of stock: The pharmacy doesn't carry Belsomra or has temporarily run out
• Prior authorization required: The patient's insurance requires PA before dispensing
• Step therapy denial: Insurance requires documentation that generic alternatives were tried first
• Sticker shock: The patient sees the cash price ($450+) and hesitates to fill

Each of these can result in the patient leaving without their medication. Proactive planning can address most of them before they occur.

Strategy 1: Choose the Right Pharmacy Up Front

Not all pharmacies are equal when it comes to stocking brand-name medications. Consider these recommendations:

Large Chain Pharmacies

CVS, Walgreens, Walmart, and Rite Aid are more likely to have Belsomra in stock or to be able to order it quickly. Their centralized distribution systems and higher volume make it easier to maintain stock of brand-name medications.

Mail-Order Pharmacies

For patients with stable prescriptions, mail-order through their insurance plan is often the best option. Benefits include:

• Consistent availability
• Home delivery convenience
• Often lower copays for 90-day supplies
• Reduces refill anxiety

Common mail-order pharmacies include Express Scripts, CVS Caremark, OptumRx, and Amazon Pharmacy.

Specialty Pharmacies

Some specialty pharmacies stock DORAs more consistently. If your health system has an outpatient specialty pharmacy, it may be worth checking whether they carry Belsomra.

MedFinder for Providers

MedFinder for Providers offers a pharmacy locator tool that helps identify pharmacies with Belsomra availability in real time. Share this with your patients or your staff to streamline the dispensing process.

Strategy 2: Preempt Insurance Barriers

Insurance hurdles are the most common source of delay. Here's how to stay ahead of them:

Submit Prior Authorization at Prescribing

Don't wait for the pharmacy to submit a PA request. Include the following in your proactive PA submission:

• Diagnosis: Insomnia (ICD-10: G47.00 or F51.01)
• Prior medication trials: Document names, doses, durations, and reasons for discontinuation
• Clinical rationale for Belsomra: e.g., DORA mechanism preferred due to lower abuse potential, failed Z-drugs, elderly patient, etc.
• Supporting documentation: sleep study results, prior authorization forms for the specific payer

Anticipate Step Therapy Requirements

Most payers require trial of at least one generic alternative before approving Belsomra. Common step therapy agents include:

• Zolpidem (generic Ambien) — typically first-line
• Eszopiclone (generic Lunesta) — often accepted as second-line
• Ramelteon (generic Rozerem) — some payers accept this

Document all prior trials thoroughly in the patient's chart to facilitate PA approvals.

Appeal Denials Promptly

If a PA is denied, appeal with additional clinical documentation. Peer-to-peer reviews can be particularly effective for DORA prescriptions when you can articulate why the GABA-ergic alternatives are inappropriate for the specific patient.

Strategy 3: Address Cost Barriers

Even with insurance, patients may face significant out-of-pocket costs. Have your staff prepare to share these resources:

Merck Savings Card

Commercially insured patients may qualify for the Merck Belsomra Savings Card, which can reduce copays to as low as $0. Available at activatethecard.com/8193. Not valid for government insurance (Medicare, Medicaid, Tricare, VA).

Merck Patient Assistance Program

Uninsured or underinsured patients who meet income criteria may receive Belsomra free of charge through Merck Helps. Your office can assist patients with the application process.

Prescription Discount Cards

For cash-paying patients, discount programs like GoodRx and SingleCare can reduce the price, though savings are modest for brand-name medications compared to generics.

For a comprehensive patient resource on cost reduction, refer patients to our guide: How to save money on Belsomra.

Strategy 4: Have Alternative Plans Ready

When Belsomra is truly inaccessible, having predefined backup options prevents treatment gaps:

Same-Class Alternatives (DORAs)

• Dayvigo (Lemborexant): 5 mg or 10 mg nightly. Similar mechanism, shorter half-life.
• Quviviq (Daridorexant): 25 mg or 50 mg nightly. Favorable next-day functioning data.

Note: These may have similar availability and payer challenges.

Different-Class Alternatives

• Zolpidem: Generic, $10–$30/month, widely available. Best for sleep onset.
• Eszopiclone: Generic, $15–$40/month. Approved for long-term use. Both onset and maintenance.
• Low-dose Doxepin (3–6 mg): Not a controlled substance. Effective for sleep maintenance.
• Ramelteon: Melatonin receptor agonist. Not a controlled substance. Sleep onset.

Strategy 5: Set Up Systems for Your Practice

Consider implementing these workflows to reduce the burden on providers and staff:

• Create a Belsomra prescribing checklist: Include PA submission, savings card information, pharmacy recommendations, and backup medication plan
• Maintain a pharmacy contact list: Track which local pharmacies reliably stock Belsomra and DORAs
• Train support staff: Empower medical assistants and care coordinators to handle PA submissions and savings card enrollment
• Use e-prescribing strategically: Send prescriptions to pharmacies you know stock Belsomra

Patient Communication Tips

Set expectations during the prescribing visit:

• "Belsomra is a brand-name medication that may not be in stock at every pharmacy. Let me help you find one that carries it."
• "Your insurance may need prior authorization. We're going to submit that today so there's no delay."
• "If the cost seems high, here are programs that can help reduce your out-of-pocket expense."

Proactive communication builds trust and reduces patient frustration.

Resources for Providers

• MedFinder for Providers — Pharmacy availability and patient tools
• Belsomra shortage update for providers
• Merck Patient Assistance Program
• How to help patients save money on Belsomra