All *HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS*

Ambien CR Tablet Extended Release 12.5 MG Oral
Ambien CR Tablet Extended Release 12.5 MG Oral

Zolpidem Tartrate ER

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ambien CR Tablet Extended Release 6.25 MG Oral
Ambien CR Tablet Extended Release 6.25 MG Oral

Zolpidem Tartrate ER

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ambien Tablet 10 MG Oral
Ambien Tablet 10 MG Oral

Zolpidem Tartrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ambien Tablet 5 MG Oral
Ambien Tablet 5 MG Oral

Zolpidem Tartrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Amytal Sodium Solution Reconstituted 500 MG Injection
Amytal Sodium Solution Reconstituted 500 MG Injection

Amobarbital Sodium

Tier: 3
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 10 MG ORAL
Belsomra TABLET 10 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 10 MG ORAL
Belsomra TABLET 10 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 15 MG ORAL
Belsomra TABLET 15 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 15 MG ORAL
Belsomra TABLET 15 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 20 MG ORAL
Belsomra TABLET 20 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 20 MG ORAL
Belsomra TABLET 20 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N
Belsomra TABLET 5 MG ORAL
Belsomra TABLET 5 MG ORAL

Suvorexant

Tier: 2
PA Type: No Prior Authorization
ST: N