Eszopiclone (Lunesta and others)

How Medicare covers it

Part D (tablets taken at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Treatment of insomnia — trouble falling asleep and trouble staying asleep. In controlled outpatient and sleep laboratory studies, Lunesta given at bedtime decreased sleep latency (the time it takes to fall asleep) and improved sleep maintenance (staying asleep). The clinical trials performed in support of efficacy were up to 6 months in duration.

What it is for, in depth

Lunesta is a prescription sleep medicine for adults with insomnia — people who have trouble falling asleep, trouble staying asleep, or both. In the studies behind the label, taking it at bedtime shortened the time to fall asleep and improved sleep maintenance, in trials lasting up to 6 months. It fits in the treatment path as a bedtime hypnotic taken at the lowest effective dose: it is not a daytime medicine, the prescriber is told to reevaluate the diagnosis if insomnia persists after 7 to 10 days, and older patients are dosed lower because of greater sensitivity and next-morning motor and cognitive effects. Anyone who has a complex sleep behavior on it must stop it at once and not take it again. It comes as film-coated tablets in three strengths — 1 mg (light blue, round), 2 mg (white, round), and 3 mg (dark blue, round) — each supplied in bottles of 30 tablets.

How it works

Eszopiclone is a nonbenzodiazepine hypnotic (sleep medicine) — a pyrrolopyrazine derivative of the cyclopyrrolone class. The label says its mechanism of action as a hypnotic is unclear; however, its effect could be related to its interaction with GABA-receptor complexes at binding domains located close to, or allosterically coupled to, benzodiazepine receptors. GABA is a calming chemical messenger in the brain, and acting at those receptor complexes is thought to produce the sleep effect.

How it is taken

Take one tablet by mouth at bedtime, using the lowest effective dose for the patient. Tablets come in 1 mg, 2 mg, and 3 mg strengths, and the dose is set individually. The label cautions patients taking the 3 mg dose against driving and against activities requiring complete mental alertness during the morning after use, because alertness and motor coordination can still be impaired the next morning. Older patients should use a lower dose.

Common side effects

The adverse reactions section of this label extract does not give a percentage table of common effects; the effects the label stresses are those of a sedating sleep medicine: impaired alertness and motor coordination, including the risk of morning (next-day) impairment, and abnormal thinking and behavioral changes such as decreased inhibition, bizarre behavior, agitation, and depersonalization. In the pediatric information — where safety and effectiveness are not established — dizziness, dysgeusia (a distorted sense of taste), hallucinations, and suicidal ideation were reported.

Serious warnings

BOXED WARNING: complex sleep behaviors — including sleep-walking, sleep-driving, and engaging in other activities while not fully awake — may occur following use of Lunesta. Some of these events may result in serious injuries, including death. Stop Lunesta immediately if you experience a complex sleep behavior, and never take it again afterward: Lunesta is contraindicated in patients who have experienced complex sleep behaviors after taking it. Other serious warnings: CNS depressant effects with impaired alertness and motor coordination increase with dose and with use of other CNS depressants and alcohol. Severe allergic reactions, including anaphylaxis and angioedema (swelling), have been reported — do not rechallenge if such a reaction occurs. Worsening of depression or suicidal thinking may occur. Withdrawal symptoms may occur with rapid dose reduction or discontinuation. If insomnia persists after 7 to 10 days of use, the diagnosis should be reevaluated.

Boxed warning

Complex sleep behaviors including sleep-walking, sleep-driving, and engaging in other activities while not fully awake may occur following use of Lunesta (eszopiclone). Some of these events may result in serious injuries, including death. Discontinue Lunesta immediately if a patient experiences a complex sleep behavior.

Who should be careful

People who have ever experienced a complex sleep behavior after taking Lunesta, and people with known hypersensitivity to eszopiclone, must NOT take it. Older patients should use a lower dose because of impaired motor and cognitive performance and increased sensitivity. Use with caution in patients with liver (hepatic) impairment, impaired breathing (respiratory) function, impaired drug metabolism, or impaired hemodynamic responses. People with depression should be watched for worsening depression or suicidal thinking, and prescribers should give the least number of tablets feasible to avoid intentional overdose. Safety and effectiveness in children are not established.

Major interactions

Other CNS depressants have additive CNS-depressant effects when combined with Lunesta, and use with ethanol (alcohol) causes additive psychomotor impairment — in plain terms, alcohol and other sedating drugs make the sleepiness and impairment stronger. Rifampicin (rifampin) combination use may decrease exposure to and effects of Lunesta. Ketoconazole combination use increases exposure to and the effect of Lunesta, so a dose reduction of Lunesta is needed.

Cost and saving notes

Medicare facts: eszopiclone is sold as a generic tablet in the same 1 mg, 2 mg, and 3 mg strengths as brand-name Lunesta, and the generic is the standard lower-cost form for this Part D tablet taken at home; there is no need to pay brand Lunesta prices unless your prescriber specifies the brand. If your own Part D plan places it on a higher tier than expected, you or your prescriber can ask the plan for a tier exception when the lower-tier options would not work as well for you. If you qualify for Extra Help (the Part D Low-Income Subsidy), your premiums and copays drop a lot. In 2027, what you pay out of pocket for covered Part D drugs is capped at $2,400 for the year, and the Medicare Prescription Payment Plan lets you spread those costs into monthly payments instead of paying large amounts at the pharmacy counter. Ask your pharmacist or your plan what you would actually pay before you fill.

Why it is in its tier

Eszopiclone (Lunesta and others) sits on Tier 4 in 48.13% of the plans that list it (1470 of 3054 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $99.23 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 55.58% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• LUNESTA (ESZOPICLONE) TABLET, COATED [WAYLIS THERAPEUTICS LLC] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Eszopiclone

What official patient guides say

Eszopiclone comes as a tablet to take by mouth. Take it once a day at bedtime, or after you have gone to bed and have not been able to fall asleep. Do not take it with or shortly after a heavy, high-fat meal. Take it exactly as directed, and do not take more or less of it or take it more often than prescribed. You will probably become very sleepy soon after you take it, so take it before you go to bed. Only take it if you will be able to stay in bed for at least 7 to 8 hours afterward. Eszopiclone should only be taken at bedtime. If you did not take it before you went to bed and you cannot fall asleep, you may take it if you will be able to stay in bed for at least 7 to 8 hours afterward. Do not stop taking it without talking to your doctor, especially if you have taken it for a longer time. Keep it in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture, not in the bathroom.

Source: MedlinePlus — Eszopiclone

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 0.10656 per unit (ESZOPICLONE 1 MG TABLET) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 3,054 list Eszopiclone (Lunesta and others) — 55.6% of plans. Most of those plans put it on Tier 4: 1,470 plans, 48.1% of the plans that list it. Other plans place it on Tier 3 (1,000 plans), Tier 2 (368 plans) or Tier 1 (216 plans). For example: CareSource MyCare Ohio (HMO D-SNP) puts it on Tier 1; Humana Total Complete (HMO) puts it on Tier 4; Humana Dual Integrated (HMO D-SNP) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.