Provigil & Medicare

[dm0329]

Does anyone know if Medicare will pay for a Provigil prescription? Nuvigil?

Since these are "off brands" for MS fatigue, does anyone know what fatigue medications Medicare will pay for?

[duckfan]

Hi,
My husband tired to get a prescription filled for Nuvigil and Medicare turned it down stating that it wasn't indicated for Multiple Sclerosis. We then tried Provigil and they said the same thing. FDA apparently doesn't recognize either drug for MS. We had his Neuro write a letter but that didn't help either. I called the drug companies and wrote letters but no go. We finally gave up. Sorry I don't have a more uplifting report for you. Good luck.

[M.A.F]

hi,i was DX's in 2004 and am on medicare. i have been on then off and now back on Provigil.
I see a MS specialist.at a MS clinic.mark

[M.A.F]

Hello,I'm Sorry i also have blue cross with a high co-pay thur my wife (she is retierd now ,I'm on SSD) I forgot. mark

[its2much]

BCBS use to cover it

Now they don't.....

[tinac]

I really don't know what the difference is but I take Provigil . My blue cross covered it as soon as my dr said it was for ms. It would have been terribly expensive except the generic form was on the walmart 4 dollar plan. My particular walmart works well with its customers and calls the insurance themselves and dogs them till they work it out. Could it be that your dr is not giving them a definite dx?

good luck to you and maybe with the right advocate you can get it going. Provigil works for me and with no side affect..I hope the same for you!


good luck
tina

[weena]

Fatigue meds

I am on SSD and was on Provigil for a year or so and now I'm on Adderall. I have had no problems getting it covered by Medicare because of the way my Dr. listed it on my chart. I do have "a mild case of ADD" and they have no problem covering the meds for that. I wish they would accept it for MS, the fatigue is my biggest issue and when I don't take a dose I know!

[alanpgh]

Provigil still not covered in 2013... How is this possible?

There is something very strange going on with many Insurance Companies with regard to coverage of Provigil.

I thought the problems with insurance coverage for Provigil might have been solved by now, but apparently coverage is still very uneven from State to State and from one insurance company to another.

I live in Western PA and have had BCBS of Western PA for many years, now called highmarkbcbs.

Here is my story:
6-8 years ago, Provigil was always denied for MS as off label. The MS Specialists in W. PA ganged up in appealing to the Insurance Companies in Western PA. After a few years, HighmarkBCBS allowed Provigil for people diagnosed with MS with no appeal needed. A new prescription is needed every 6 months, probably because of the drug category.

For several years I paid a $40. co-pay for 30 days locally (or 90 days by mail order) of 200mg Provigil, 2 pills per day. That was great.

Now, here's the kicker... When Provigil went Generic, even though still made by Teva (who bought Cephalon), my co-pay went down to $5.

I have private insurance. People on Medicare in PA can get Provigil for MS, but there is a co-pay and the donut hole. I don't have experience here, but I know people who do.

So, how is it possible that in some States, like Oregon, it can be almost impossible to get Provigil. In some States or insurance companies, it is not in the drug formulary.

Does anyone have some insight here for States other than PA? Anything specific for people on Medicare? Anything specific for my friends who live in Oregon or in other States in the Pacific Northwest?

Any help is really appreciated! Sharing experience here will help all of us.

Thanks,
Alan

[onlyairfare]

Each state and each insurance company may have its own coverage rules about Provigil, which is not FDA-approved for multiple sclerosis.

Even Medicare, a federal program available in all 50 states, has different administrators in various states, so there may be different coverage rules.

The FDA has approved Provigil for "Shift Work Sleep Disorder" (SWSD) which is intended for those individuals who work rotating shifts on their jobs - up all night one week for the night shift, then up all day the next week for the day shift. If your life resembles that - sometimes you need to be up all night babysitting or driving a long distance, other times you have to be alert all day - you might have something "like SWSD" and qualify for coverage.

When one of my insurers denied coverage for Provigil, I appealed and included copies of the medical journal articles showing benefit for MS fatigue, and then coverage was approved.

[Fed Up]

My M.D. mentioned he 'prescribes' provigil for 'depression' to get it 'approved' without any effort.

If a medication is not 'approved' by my HMO, my Doc CAN write 'waivers' to get approval. Which means more work for my doc and yours.

It seems, as stated by tinac...ask the pharmacist to call your M.D. and have a 'talk' and teach your M.D. what he needs to write on the Rx to get 'approval' without all the fuss.

When you find out what works...please let us know?

Plus, right now, many shifts are 'happening' in healthcare to change it. These issues are definitely the "kinks" we need to get worked out, now, before it is ALL set in cement! imho...fed