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    AriD, wish I could take credit for being such a kind and generous human being, but I was actually researching for my own benefit. If you look a few posts back, you'll see that I'm in the same boat that you were--trying to get Caremark to authorize. Guess I shouldn't be so hopeful about finding this after hearing of your experience.
    Dx 07/13


      Sorry J-Bo, I lose track of the start of threads. I still appreciate you passing on the information.
      Do you wake up often at night? I meet no criteria for sleep apnea except higher risk because of MS (not overweight, normal neck size and length, no airway issues, etc) We just did the study on a fluke in hopes to get the Modafinil approved. My doctors and I were shocked it came back positive. The home study is simple and even if you show mild apnea, you will get the medication. My insurance covered the test 100% too. May be worth a try?


        I learned from you all about Provigil being on label for Sleep Apnea, in addition to Narcolepsy

        Many people with MS have sleep apnea.

        i have been on a CPAP machine for 10+ years. It has been transformative for me in terms of feeling like I've had a good nights sleep. And Provigil has had a transformative impact to reduce my fatigue. Everyone is different, but that is my experience.

        Also, my insurance tried to get me to use Nuvigil, a time release version of Provigil. I understand that Nuvigil works for some people, but it didn't work for me.
        I went back to Provigil, and it really reduces my fatigue. Lucky my insurance covers Provigil. I wish this coverage was consistent from one insurance company to another.

        Thank You all for the very helpful information!

        All The Best,


          Originally posted by AriD View Post
          J-Bo, you are so kind to do that research to help me out. I really don't know what to say. So kind.

          PA program is the prior authorization program. Those are meds that require special approval with specific criteria by Caremark. My doctor used everything she could get, including what you found, but Caremark said they still wouldn't approve off label use.

          HOWEVER, my doctor's nurse called Caremark today and after being passed around to several people, she reached someone and told them about my new sleep apnea diagnosis which is on label use and I was approved to get it. I called later and, after a bit of difficulty, someone finally put the order in. Should get it in about a week.

          Sorry I didn't jump on this earlier. I am a retired Federal employee hence FEP under Blue Cross Blue Shield. We use Caremark to provide my Tecfidera and Nuvigil Armodafinal. I believe Nuvigil is on the preferred drug list

          I actually fell asleep multiple times during the day today and couldn't get through more than four hours of work. Came home and slept rest of day. Have been so worried about something happening to me driving, working, etc because of how tired I am all the time. Still waiting to start cpap but hopefully between Modafinil and cpap, things will be better and safer

          I thank you for your support J-bo. And I encourage anyone with excessive fatigue to consider a sleep study. Don't know how much of a difference cpap will mean but I'm much more relieved that it allows me to get my Modafinil prescription. I've have felt so bad lately, legs much weaker, many more symptoms, and overwhelming fatigue, that anything that even helps a little will hopefully allow me to get through my day.

          Thanks again for the support
          Sorry I didn't jump on this earlier. I am a retired Federal employee..hence FEP with Blue cross blue shield. Caremark is my provider for Tecfidera and Nuvigil aka Armodafinil. I believe Nuvigil is on the preferred drug list. It was prescribed to me for MS fatigue, which is a common use , but it was not filled until I was diagnosed with sleep apnea. I just want to say that I get a much better nights sleep with the cpap machine. I hope it helps with your fatigue as well. It does take a little getting used to.

          In addition I take Nuvigil. When I first started to take it, it made me very jittery. It also took some getting used to for me. I adjusted the amount I took and the time I took it to fit the activities of my day. In my case my prescription is fairly low 150 mil. But that's just me and my experience.

          I pray that you can begin to receive a full nights sleep and that the medication prescribed for your fatigue can allow you to get through your day.


            Thank you and I'm so glad the combination of cpap and Nuvigil is helping you. I've heard from my patients that cpap can be tough. Some have likened it to putting your head out the window when driving 65 mph. Don't know yet if that is accurate but will find out soon.
            Last night I was up every hour. The study showed I stop breathing at least ten times an hour with my oxygen levels dropping way down which wakes me up. Not sure how I'm going to get through today. I have studies for bladder issues early this morning then work till late this evening.
            Hopefully cpap and Modafinil will get me back on track
            Thanks for your well wishes.


              CPAP is not tough at all for me.

              It comes down to getting the proper fitting on the CPAP mask.

              And depends on the ramp up settings and level needed for you on the machine. If you need a CPAP, I suggest you go to a sleep specialist who also specializes in Neurology who has helped many MS patients.

              Best Wishes!



                Thanks Alan,

                I do have an appointment with a sleep specialist but I have to use a cpap machine from 31-90 days before seeing her. So I go in May. Glad to hear you are doing well with cpap. It's reassuring.


                  I am also on a CPAP, and I cannot state enough how much of a difference the proper fit of a mask makes. I never realized how important a proper nights sleep is, and how much of a difference in makes.that and modafinil ( generic Provigil) has made an incredible difference.
                  MS World
                  PPMS DX 2001

                  "ADAPT AND OVERCOME" - MY COUSIN


                    That's great to hear. Glad it has helped you.


                      I got my Modafinil in the mail yesterday. Yay!! And appointment to start cpap next week. Hoping for better days!


                        Originally posted by hunterd View Post
                        I am also on a CPAP, and I cannot state enough how much of a difference the proper fit of a mask makes. I never realized how important a proper nights sleep is, and how much of a difference in makes.that and modafinil ( generic Provigil) has made an incredible difference.
                        Here's a related post from another thread on "MS, Sleep Problems and Fatigue..."

                        Any and all comments are appreciated!