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    #16
    I live in Massachusetts. My insurance wouldn't cover either drug unless diagnosis of sleep disturbance. My neurologist actually copied and sent in long appeals including all the information from the MS Society three times as well as her own evidence. Didn't help still denied every time until I got sleep apnea diagnosis. Insurance said it didn't matter what MS Society said because both drugs are still considered off label for MS and therefore they wouldn't cover it.

    What's ridiculous about it is that they did approve it the year before. Just trying to save money.

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      #17
      Got my approval letter yesterday!

      Letter says they have approved coverage effective 5/26/16 (gee, can we turn back the clock?) through 8/24/2017! Neuro ordered 200mg twice a day for 30 days. I checked drug pricing - for 30 pills it's about $8 - for 60 pills it's 30 times that - $243. WHY??????

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        #18
        Originally posted by its2much View Post
        I checked drug pricing - for 30 pills it's about $8 - for 60 pills it's 30 times that - $243. WHY??????
        Is that the cost through your insurance company pharmacy?

        It may not matter where those prices came from. The discrepancy between the two prices is because the $8 price is obviously a mistake. $80 for 30 200-mg pills is still suspiciously low, but at least it's approaching the realm of reality.

        Modafinil is expensive. Even the lowest prices for 30 pills are rarely under $100. So at an average low cost of about $125 for 30 pills, the $243 cost for 60 pills is the realistic one.

        If you can actually get 30 pills for about $8, that would be a gift. You should probably say grace every time you take one.

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          #19
          took forever to get it

          I have been on for several years now. My doctor sent letters and did have the sleep study test done.
          I had to do without it last year as my insurance decided not to pay. I had hard time coping without it. Medicare does cover-I think- as does my insurance. Insurance pays for it as a Tier 4 so it does not cover that much.

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            #20
            Coverage Restrictions In Ohio

            Originally posted by hitdog042 View Post
            I am on Medicaire part D. I never had a problem but provigil didn't work for me. Switched to Adderall and also had no insurance issues. I'm in Ohio. No pre auth or anything.

            Only time that happened to me was with testosterone and the approval took like a week.
            Also in Ohio w/Medicare Part D but have had a very different experience. Very strict requirements-quantity restrictions, detailed proof of alternative medication trials, annual Prior Authorizations, Appeals. All the paperwork is off-putting to doctors and patients alike.
            Can you recommend an excellent doctor in your area?

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              #21
              Seems not to be as strict in PA.
              But it might depend on the insurance company and doctor being proactive.

              Can anyone update us on the ability to get Provigil (of course, the generic version) in other states / countries?

              Thank You,
              Alan

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                #22
                Any variation among generic manufacturers of Modafinil?

                Have any of you noticed a variation in effectiveness among different manufacturers of the generic forms of the drug?

                Many thanks for any feedback.

                Alan

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                  #23
                  Provigil prescripton was changed to Modafinal - now it is not approved for me.

                  I was on Provigil and later modafinal for almost two years. When I tried to renew a prescription a few months ago, it was denied. The reason is I have been on SSDI since April 2015 and do not have a job (last job was second shift) so obviously, poor cognition and fatigue do not matter to me anymore.

                  I am starting Amantadine this week. We shall see how that works for fatigue!

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                    #24
                    Are you appealing the denial?

                    There is a standardized appeal letter from the MS Society. I can send later if you don't have it.

                    Let us know.

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                      #25
                      Modafinil

                      Originally posted by its2much View Post
                      Just wondering how many of you have been able to get approval/prior authorization for this drug from your insurance company? Has anyone had their doctor contact the insurance company and then received a denial?
                      I have been on Modafinil for a year and have gotten preauthorized through Cigna Advantage.

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                        #26
                        I have been on Modafinil for a couple of years. I was given a script for Provigil. My insurance company balked at paying for it. My neurologist fought them and Keystone IBC relented. I began the generic, Modafinil and have been using it for several years . Good luck

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                          #27
                          Had been using modafinil for years, quite helpful for MS related fatigue. About 4 months ago, Insurance (Independence BC, Philly area) refused coverage and rejected all appeals. The Insurance company found a doc who disputed the evidence of effectiveness. To purchase a 30 day supply of 200 mg tabs would cost about $800. (!)
                          Part of this may be the FDA decision to classify the drug as Schedule iv b/o addictive potential. (Say what?) I am told that Provigil became popular with students who were using (abusing) it to try to get better grades.

                          Online pharmacies advertise the drug. Has anyone done this successfully?

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