Ins. Won't Pay for Provigil

Discussion in 'Fibromyalgia Main Forum' started by moxiepup, Aug 27, 2005.

  1. moxiepup

    moxiepup New Member

    Hi after trying every new drug that comes along, including a Bi-Pap machine I finally find something that makes me wake up refreshed and seem awake for most of the day.

    My PCP gave me samples to try started on 100mg now take a whole pill so I call and tell her it works great, she calls in the Rx for me.

    I called today to see if it's ready and they tell me my Ins Co won't pay for it without an explanation from the Dr.

    I hope Severe Obstructive Sleep Apnea is good enough cause I don't do shift work and I don't have Narcolepsy and that is all this drug was supposedly made for.

    I wonder why they are being so picky about it's off label use. Did anyone else have this happen and how did you get around it.


  2. moxiepup

    moxiepup New Member

  3. teacher

    teacher New Member

    The severe apnea should do it, but who knows with insurance companies?

    Keep me posted. I have a new insurance company as of Sept. 1. Not sure how they'll handle this.

  4. Jgavi

    Jgavi New Member

    If your insurnace company wont pay for it (your Dr should talk to them) try Dextroamphhet OR Methtlphendate they are really cheap without insurance , it might be covered, ...or try the Provigil Patient Assist Program.


  5. dunnlb

    dunnlb New Member

    I found Provigil online from 4 Corners Pharmacy. Maybe you could possibly get by on half tablet/day or at least some days. There is no shipping charge.

    1 Packet(30/packet) of Modavigil 100mg Tablets US $95.00
    2 Packets " of Modavigil 100mg Tablets US $180.00
    3 Packets " of Modavigil 100mg Tablets US $255.00
  6. Bambi

    Bambi New Member

    pain dr had to call them to get my pain meds approved for six months, I guess then he'll have to call them again. He said he will go up against them or whoever he has to because I definitely NEED the pain relief I have not been able to find with ANY other medication..even others in the same class of medication.

    I agree that you should email the maker of the drug also and see if they have any programs. My pharmacy won't fill anything the insurance won't cover..even if we are willing to pay cash for it. OR a dose the insurance won't cover. It's ridiculous that the insurance companies can override your doctor's
    decisions and more ridiculous that the pharmacies will also!
  7. elsa

    elsa New Member

    You need to find a new pharmacy. It is illegal to deny you rx medication prescibed by a MD. There is not a thing wrong with paying cash. Too many pharmacy employees don't ever think beyond insurance coverage ... they get taken back when you say I'll pay cash. They have too ... they have no choice.

    What happens to the people who have no prescription insurance coverage? They just don't get their medications?

    Walgreen's ( through a mistake on their part) denied filling my rx prescription ... reason ... insurance won't pay for it , they say it's too soon ... Fine, I'll pay cash . Stunned them .. but let me say again... THEY HAVE TO FILL YOUR RX!! Insurance cannot say you cannot have treatment or medication. They say we will not pay for it if you go ahead.

    When walgreen's pharmacy tech. tried that on me ... well, I smiled better then a cat with a rat! Had big fun correcting the error of her ways, the manager's ways and the regional supervisor's ways.

    Haven't had a problem since then.

    You guys, I'm a licensed insurance agent. DO NOT LET THESE ILL-INFORMED PEOPLE keep you from the medications you need.

    For those of you who have been denied provigil by insurance... Have doctor write rx for "excessive daytime sleepiness". This is acceptable and the working definition of narcolepsy/swing shift workers for who provigil was approved for.



  8. moxiepup

    moxiepup New Member

    Hi and thank you all, I am calling my PCP in a.m. she has no problem fighting with my ins co., she has done it before. They weren't going to pay for me to stay and extra night in the hosp 2yrs. when I was in for Asthma, I had already been in there for 7 days which is pretty unheard of now a days.

    The night before I was suppose to come home I got the worst headache of my life BP thru the roof crash cart in my room the whole nine, I thought I was having a stroke, I think they gave me my roomies med., she was diabetic.

    My Dr wanted me to stay to make sure I didn't have a brain bleed so I had to stay and have a CT on Head, anyway she won and I didn't have to pay.

    I asked the pharm how much the Rx was $308. for 30 hhhaaaaaaa like I can afford that, as it is my co-pays are killing me since my ins keeps moving everything that's popular up a tier which is $45.00 for me ouch and I take a lot of meds.

    Anyway whoever said you can purchase your scripts is absolutley correct, they hate it when you do it they no longer have the power, at least that's the way my pharmacy is.

    Thanks again I will let you guys know what happens.

  9. jaltair

    jaltair New Member

    I wrote the same things just after August 5th! My doc gave me samples for a week, they worked, she called in a prescription, and then the "blockage" by insurance began. . at this date, my doc is appealing my insurance so that I can get the Provigil.

    How maddening! Find a drug that will actually make you feel like a person and the insurance doesn't cover it because it doesn't fit a category of diagnosis!

    Some on this board have stated that their insurance covers it, some have said it can be used for "off label" (FMS would be off label), etc., etc.

    I can understand your frustration well, and will be following the replies to your post!


    [This Message was Edited on 08/28/2005]
  10. Chgogal1

    Chgogal1 New Member

    Hi Gail,

    I take Provigal. It worked in the beginning (2years), but now it doesnt seem to help me. I have been paying cash for it. I'm trying to wean myself off. It is not easy. If it still worked for me like it use to I would gladly pay. In the beginning I experinced clear thinking after taking my provigal 200mg a day. Now I'm back to where I was with the Fibro Fog. I dont mean to rain on your parade, I just wanted to tell you how it has been for me.

    Someone mentioned Dextroaphat and Methtiphendate?
    What are they ?

  11. Tigger57

    Tigger57 New Member

    You have to get the doctor to put the right diagnosis down... Mine was "Excessive Daytime Sleepiness" another wold be narcolepsy.

    Good luck,
  12. Bailey-smom

    Bailey-smom New Member

    Most of the time you should be able to get it through insurance if you have your doctor write a letter of explanation as to why you are prescribed a certain medication. I would suggest writing one yourself as well. It may help make it more personal. I wish you my best - as an agent I will also talk to our adjusters myself if I have spoken with a client that is having problems.

  13. moxiepup

    moxiepup New Member

    Thanks guys I will keep you posted on the Provigil saga :))