Provigal...Having to fight insurance to get it!!!!!!

Discussion in 'Fibromyalgia Main Forum' started by nitengal42in, Aug 18, 2003.

  1. nitengal42in

    nitengal42in New Member

    I am so mad right now, I could spit.

    I saw my rheumy last week and we decided that maybe we should try Provigal to treat my FMS/CFS. She told me all about it and I was so excited. I am so tired of falling asleep all day long.

    Well, I take the Rx to the pharmacy and they will not fill it without prior authorization from my docs office (insurance wont.)

    I jumped through all their hoops and they still denied it! They said it was not medically necessary. Huh?

    Now I am in the process of appealing their decision. My doc has to write a letter of medical neccessity and fax it in. It could take them 10 days just to get it back from the transcriptionist...so I am looking at probably a month more before I know anything.

    Why do insurances have to be so bad? The doc specializes in the tx of FM/CFS...UGH!

    Sorry, needed to vent.

    Stacey
  2. Mikie

    Mikie Moderator

    I know how stupid this seems, but you are on the right track. If they turn you down again, find out what the next step is in the grievence process. If you have exhausted all grievence steps, write a letter threatening to file a complaint with the state Insurance Commissioner's office charging non treatment of a serious condition. If they still don't respond, file the complaint. Fatigue so severe as what we have is a danger to us and others when we drive. There is currently no comparable drug for Provigil. Other stimulants can be harmful to us. Managed-care plans can refuse coverage of drugs during the first few months or a year after they have been approved. I don't know how long it has been since approval of Provigil. Also, it has been approved for the treatment of narcolepsy, so I don't know about approving its use for our type of fatigue.

    Good luck and I hope you prevail. Let us know.

    Love, Mikie
  3. garyandkim

    garyandkim New Member

    narcolepsey (sp) to get it. Tell your doc that. I asked the our company why and they said it is for narcolepsey and that must be the reason. It worked for us. Good luck, Kim and Gary
  4. painin

    painin New Member

    I have been on provigil since December. I too had to fight with the insurance co. But my neurologist's office did it for me. Started out with 100mgs every morning. And then was upped on my dosage to 200mgs every morning. My insurance co has me approved until the end of this year. I suppose I will have to have prior approval by them again when the new year starts. Provigil has really made a difference for me. I'm not sleeping all the time now, but my body still gets so tired, & when I lie down to take a nap,to give my body a rest, I find it takes me over an hour to get to sleep because my brain is still racing. Good luck! And I hope you get your approval so that you may try it out to see if it helps. When I 1st sarting taking it, I'm thinking that it took me about 6 weeks to get used to it.Again, good luck!!
  5. RoseSky

    RoseSky New Member

    I had to fight with the insurance too. I was denied the first time around and then denied again after the letter of medical necessity - insurance company said they only approve it fir narcolepsy. My prescription was actually written by a psychiatrist, not my regular doc. With my insurance, they have a separate company that handles mental health claims and this company has a doctor on their board that can over-ride the decisions of the medical insurance company. That is what I had to do to get it approved. That guy over rode all the denials for me. But even once I got it approved they would only pay for 30 pills a month - enough for 1 a day. Well, by then I was up to taking 2 200mg pills in the morning and 2 more at lunch time. I built up such a tolerance that I hardly ever even bother with it anymore.