Chronic insomnia treatment and Medicare Part D: implications for managed care organizations

The elderly population is of particular concern with regard to insomnia and managed care. Early intervention and management of insomnia as a chronic disease are recommended. Increased awareness of the negative clinical and economic consequences associated with not treating insomnia may serve to raise the perceived importance of having effective formulary options for this disease area. Because the elderly population is now covered by Medicare Part D, health plans previously without a Medicare drug benefit must now select and reimburse for sedative-hypnotics for the elderly. A review of the major Medicare Part D plans' formularies reveals they offer a limited number of sedative-hypnotic alternatives, but not all are available. Due to variable response, variation in comorbidities, drug and disease interactions, and individual patient needs, managed care organizations should cover a reasonable array of drugs. This is essential to optimally manage patients with chronic insomnia to reduce the long-term clinical morbidity and economic consequences.