Anthem prior authorization denial for Xywav help

Hello! I am on my third denial trying to get a specialty medication approved with insurance called Xywav (a narcolepsy medication). The first needed information about a sleep study, then the second asked for trials of modifinil and at least one ADHD medication. This was all sent.

On the third one, it is stating this as the reason for denial: "We denied your request because we did not see what we need to approve the drug you asked for, (Xywav). We may be able to approve this drug when we see certain records (documentation confirming trials of wakefulness promoting agents and stimulant agents are unacceptable due to concomitant clinical situations including but not limited to cardiovascular disease or drug interactions). We based this decision on your health plan’s prior authorization clinical criteria named Xyrem (sodium oxybate), sodium oxybate – brand, Xywav (calcium, magnesium, potassium and sodium oxybates). Medications that are not medically necessary are an exclusion under your plan benefits and are not covered. "

This medication was approved with zero hassle under Aetna for about 7 years, but Anthem is asking a lot.

If anyone can help, what does the message mean above? I'm not certain what it is asking for – any guidance on getting through all these hoops?

Thanks for any advice you might have, community!

submitted by /u/mrsaturnboing
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