Provigil insurance denial

[emily06]

Didn't know where to submit this post. But my insurance (as usual) has denial my doctor's request to get me medicine to help. How did any of the others on this board get their insurance to approve generic Provigil for their MS? Please help!

[beingmindful]

We have our denial on appeal right now; if we win, I will post. From what I understand, Provigil is approved to treat people with sleep disorders. It is prescribed "off label" for MS fati gue, so they techniacally feel justified in denying. The neurologist sent info to the insurance co that my DH had had a sleep study, and we may win the appeal based on that.

Your neuro should appeal the denial. Let us know how it goes. By the way, we have Blue Shield California, a private plan that we pay A LOT for. We are dismayed that we can't get coverage for this needed medication.

In the meantime, we are trying a no-gluten/no dairy, no legume diet and hoping that will help.

[pennstater]

I had the same problem. They would not approve it for off label use and since I don't have narcolepsy, not covered.

I wound up ordering from Canadian pharmacy. Much cheaper than US. Still need the Rx, 90 day supply with 3 refills.

[its2much]

Cost at A Canadian Pharmacy

Pennstater - do you mind sharing the cost of Provigil from a Canadian pharmacy? Dosage and number of pills as well? My insurer, who will not pay for it, claims the cost is about $200 for a 30 day supply (60 pills) of 100 mg pills.

[its2much]

Oops the cost here is

$2000, two thousand, not $200 for the 30 day supply of 100 mg pills! (Quite a difference than my typo first indicated!)

[Sissy]

My Neuro put me on Nuvigil when I was DX. I had been on Provigil for narcolepsy. Some one needs to have a serious talk with the INSURANCE COMPANY'S!!! They are running this country!!

They have no idea what people need! Why do Dr. and Pt's have to answer to them ?? I've had it explained to me but I can't repeat it here!

[its2much]

My insurance no longers covers

Nuvugil as well. My insurer previously covered provigil (5-6 years ago) but no longer do. To add further frustration, my neuro has yet to appeal the insurer's denial...

[pennstater]

Sorry for the delay. I haven't ordered lately since I have been on prednisone so often. Last time I ordered it was a 3 month supply, 100mg 2x/day. It was $281 and was Modafinil, a generic. It is Pharmaweb in Canada, but meds ship from India. You can also check with your doctors to see if they know any options and shop around. It was my primary physician who gave me the name, as he orders for his parents when they hit the medicare hole.

[Teddy1101]

Provigil

I had it approved last year and I am on Medicare. They would not allow for Nuvigil which works a lot better for me.
The Provigil makes me nervous and panicky.

Thanks

[69Mustang]

I had no problem getting Rx for Adderall covered this year with Aetna & they want to precert Everything. I rarely use it but it is generic and cheap & ins covers it.

I have used Provigil in the past. I like Adderall better. Also my Rx is written for 1 twice daily. I usually only need 1/2 tab when I use it. So my monthly Rx of #60, lasts 120 days if I take it every day. Downside- you need a hard copy Rx for this (cannot be called in). My doc mails me the Rx when needed then I drop it at the pharmacy.

Also look into the cost at your local BigBox- SAMs, Costco, etcetera.

They don't tell you but they have to sell to you (Rx and liquor) without a membership- that's the law. They don't want to stop you really, they just don't advertise it, hoping you spring for membership.

If you want the price just call, say "I need the price for (drug name) number 90 (or whatever your Rx is for)." They will give you prices with no hassle.

Keep in mind it is cheaper to buy in stock quantities of 90 or 100 usually, but you need to know the price break point. So either ask if the stock bottle comes as 90 or 100 tabs per bottle. Sometimes it doesn't make a difference on the price but it often does.

I was a pharmacy tech all through high school & undergrad- hence my knowledge & experience with this.

Good luck!

[beingmindful]

Generic Provigil

Insurance company denied the appeal. BUT GET THIS! IT'S AVAILABLE AS GENERIC FOR $59.24 PER MONTH!!! Compared with $667 for the brand name, we are hopping right on this. Why the neurologist never told us this, and we have been waiting since AUGUST to get this medication, I have no idea. I am running to the pharmacy NOW.

[ktlaw107]

Response to Provigil denial

Blue Cross denied me even with a pre-authorization. I ran it under my secondary insurance which is United Healthcare and they automatically filled it. Insurance companies have way more control over our treatment than they should.

[alanpgh]

Insurance companies will often fill prescriptions for Provigil.
Sometimes they try to limit to 100 mg twice a day.

If they say "No" be persistent and seek a letter from your Neuro; or, I think the National MS Society has a letter you can request.

Here in Western PA, near Pittsburgh, Highmark and UPMC gave approval a number of years ago because the well-known neurologists here were aggressive and provided information to the insurance companies as to the effectiveness of Provigil for people living with MS.

Best Wishes!

Alan

[pennstater]

Beingmindful,

What is the generic and where are you getting it filled? Is it modafinil? I tried to get that filled last year and it was $480 for a 90 day supply of 100 mg a day. I would love it if there is a way to get it cheaper in the US.

As for the pro vigil and even Modafinil, It seemed like both Aetna And IBX covered my first Rx each year, then on renewal, it was flagged. I am sure system loophole, which was closed last year at IBX. When I only needed 200mg a day, neuro would order 200 mg pill so I could cut it and get 180 days out of the 90 day Rx.

[69Mustang]

Magic words for Med Approval

Try asking for a supervisor with your insurance company and tell them you are "out of compliance" with your regimen due to their delay in approving the treatment or med.

For some reason these words trigger something for them and you become a high priority. By being persistent and repeating that phrase you will get results.