Provigil

[its2much]

My insurance company has denied my prescription for Provigil. I did take it previously and my insurance covered it at that time. Most recently have taken Ritalin which became less effective.
Has anyone successfully appealed an insurance denial of Provigil? Doctor's office says it's very hard to get approved.

[Justsayyes]

I had some trouble getting it approved initially, but it was the doctor's office that needed to submit further info. I went off Provigil for awhile and on Ritalin, which was OK, I just thought Provigil was easier to get because it wasn't a class of drug that required a lot of hoops to jump through.

Didn't have any trouble getting a new prescription filled. Now that there is a generic, I don't know why it would be difficult. I can see that it might have been when the cost escalated to a crazy amount when Nuvigil was introducec on the market.

Sorry for all the rambling, I think you should continue to appeal and ask your doctor for assistance. Also check with your insurance yourself so you know what is required to get it. You may find the ball is dropped somewhere along the way.

[its2much]

My insurance company

says they only pay for Provigil for narcolepsy and sleep disorders. My fatigue is overwhelming.

[Justsayyes]

Geez what is your insurance? My insurance at the time I started Provigil also said it was approved only for narcolepsy and sleep disorders, all their information said that, but they approved it to be used "off label". My insurance was Guardian at that time. I have Anthem now and there is no problem.

I would definitely appeal a denial. In the meantime, maybe ask to use a different ADHD medication than Ritalin. Some here prefer Adderall. Ritalin is probably the mildest of the ADHD meds. It is easy to build a tolerance to meds, including Provigil. I take a day off every week to prevent that.

[misslux]

Will they approve the generic modafinil?

[its2much]

No

they won't approve the generic either..... The insurance's website lists the cost of both drugs around $2000 per month - the generic is listed about $100 less.....

[its2much]

Just curious

how many of you have neuros that say they will appeal the Provigil denial. It's been six months and the doctor has done NOTHING - any suggestions what to do???

[beingmindful]

my husband's neuro sent in the appeal today. fingers crossed.

[webbles989898]

I have Blue Care Network and they will not approve it no matter who appeals.

[its2much]

weebles

Is that a Blue Cross Blue Shield plan? Have you found any other drug that has helped with your fatigue? I'm so sick and tired of being tired!

[Mermaid52490]

Teva Pharmaceuticals will "grant" nuvigil when insurance denies coverage

I had blue shield for years, and paid $900 a month for provigil. The manufacturer changed the formula, the name and the patent, so I had to pay twice as much for nuvigil. If you dig through the Nuvigil website, and research "patient assistance" you will come across a program called "Teva Cares". With the right documentation (prescription from doctor, proof of denial of insurance coverage) and about 3 months of vigilant phone calls and resubmitting forms, its possible to receive three months worth of nuvigil from Teva, at no cost. I continued with this assistance (and the constant paperwork and phone calls) until I switched insurance providers, and the medication was covered. It may have been an administrative nightmare - but it was worth it. Paying thousands of dollars for the one medication I found that actually works for MS fatigue, was not acceptable. I encourage you all to dig in, and apply to the Teva Cares program.

[AriD]

I was denied by my insurance for provigil also. Same reason only approved for narcolepsy and other sleep disorders, not ms. After many months of trying to get my doctor to complete paperwork, it was finally approved for nuvigil. My insurance blamed the delay on my doctors office for not communicating and vice versa. Who knows?

Just started taking it three days ago. I feel a little more dizzy than usual on it. Is that common?

[SNOOPY]

Hi AriD,

Just started taking it three days ago. I feel a little more dizzy than usual on it. Is that common?

Dizziness is a listed side effect of Nuvigil.
http://www.nlm.nih.gov/medlineplus/d...s/a607067.html