Diagnosis: Idiopathic hypersomnia
Treatment: Modafinil 200mg OR TABS
The insurer denied the Modafinil 200mg OR TABS.
The denial is overturned.

The patient is a male who presented with excessive daytime sleepiness. He underwent polysomnography (PSG) with multiple sleep latency test (MSLT). The diagnosis was consistent with idiopathic hypersomnia. The request is for Modafinil.

Yes, the prposed treatment with Modafinil is medically necessary in this patient at this time.

The American Academy of Sleep Medicine recommends the use of the following central nervous system (CNS) stimulants as an option as there is no standard of care medication approved by the FDA for the treatment of this condition. The medications include:
- methylphenidate
- amphetamine/ methamphetamine
- Modafinil/armodafinil.

Therefore, the use of Modafinil in this patient with idiopathic hypersomnia is medically necessary as supported by the American Academy of Sleep Medicine.