Some States Extend HETLIOZ Coverage to Patients With Non-24 Who Are Not Totally Blind

HETLIOZ (tasimelteon), a drug for non-24-hour sleep-wake rhythm disorder, is now available for without vision status restrictions for non-24 patients on Medicaid in the state of Colorado.

In November 2021, a HETLIOZ patient filed a federal lawsuit challenging the unlawfulness of Colorado Medicaid’s prior authorization criteria, which limited HETLIOZ coverage to totally blind patients. In response to the lawsuit, Colorado changed its criteria to cover HETLIOZ for all non-24 patients and to no longer restrict HETLIOZ coverage on the basis of vision status. 

Since then, 10 additional states have revised their criteria to eliminate the restriction of HETLIOZ coverage to totally blind patients.

HETLIOZ, which is marketed by Vanda Pharmaceuticals, saw net product sales of $173.5 million for the full year 2021, an 8% increase compared to $160.7 million for the full year 2020.

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