Payer Perspective of the American Academy of Sleep Medicine Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia

The recently published clinical practice guideline of the American Academy of Sleep Medicine (AASM) for the pharmacologic management of chronic insomnia (“the guideline”)1 represents the first comprehensive, evidence-based analysis of individual agents commonly used in the treatment of chronic insomnia. This guideline includes specific recommendations for or against the use of many commonly prescribed and over-the-counter medications. These recommendations were developed using the GRADE methodology (Grading of Recommendations, Assessment, Development, and Evaluation). The quality of evidence, benefits versus harms of the treatment, and values and preferences were all considered from the perspective of clinicians and their patients. These values and perspectives may, at times, differ from those of a payer. Therefore, in light of the clinical and economic implications of these recommendations, it is of great importance that they be interpreted by payers in an appropriate context, and with a clear understanding of the strengths and limitations of this process. This publication addresses appropriate interpretation of the guideline by payers, in an effort to promote sound decision-making in the pharmacologic management of insomnia.