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405614 tn?1329144114

Latest news about Provigil...

Do you think insurance will cover it for fatigue from Sjogren's Syndrome?

I just got a call from my PCP's medical assistant regarding my letter asking for help getting approval for Provigil.  She said that Dr. S. said that Dr. Y. needs to do the research since she prescribed the Provigil.  

I explained that Dr. Y. prescribed the trial rx, and that Dr. S. had written a rx for "fatigue from cerebral white matter disease", that Dr. Y. hasn't considered that as a diagnosis, that she has MS as a differential diagnosis.  

Dr. S. said that it would take her a month to research cerebral white matter disease, that she's very busy.  I was very understanding and had the medical assistant laughing, as I explained that I really had no diagnosis, but I may have gotten one today and she should call me so I can run over and get some blood drawn when they hear from Dr. H, that maybe a new diagnosis would work.  

So, bottom line; no diagnosis, no approval from insurance.  I don't understand why Dr. S. could write "fatigue from cerebral white matter disease" without having done any research on said disease!  If she can do that, why can't she say that I'm strongly suspected of having MS?  I don't know if that would work, either.

I just called my pharmacist, and he told me that I don't want to know how much they cost.  We laughed, and I told him that I could take it.

It would cost me from $5 to $10 a day, depending on my level of fatigue.  The bizarre thing is that it would be worth it to me, and I'm trying to figure out a way to afford it.

If Dr. S. will say it's medically necessary, then I can use it as a medical expense, ask for an interim review, and get my rent lowered.  I could call my disability worker, fax her the medically necessary paper, and get an increase in food stamps.

It really has made that much difference.  If I wouldn't have had 100 mg. today, there is no way I could have driven to my 8:15 am appt., or stood the 4 hours of tests and asked intelligent questions and remembered as many of his answers as I do, driven home, etc.

I'm going to research whether insurance covers Provigil for fatigue from Sjogren's Syndrome, in case I get that diagnosis.

The improvement in my quality of life was so dramatic that it was amazing to me.  It made me feel ABLE instead fo disabled.  It doesn't fix everything, but it helped me a heck of a lot.

Enough on this subject already!  Had to vent.

Thanks for listening,

Kathy
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405614 tn?1329144114
Narcolepsy is one of the "approved" diagnosis, but only if you've tried other (cheaper) drugs and couldn't take them.  Aren't insurance companies a kick in the pants?

Unfortunately, my doc doesn't have samples; I got a coupon from the drug company for a trial prescription.  100 mg. worked great!

This will work out, I know it will.  If all else fails, there's Ritalin or Adderall, if my heart rate doesn't hit the roof.  I stubbornly don't want to take that chance.  Been there, didn't like it!

Kathy
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Avatar universal
My insurance has also denied the initial request for Provigil and I have a dx of Cataplexy/Narcolepsy!  However my doctor is giving me plenty of "sample" packs while this works out.  Any chance you can get more "samples".  And, the absorption into your body isn't altered by cutting the pill in half, so if the cost changes, it may be good to get the 200mg pills and cut them in half.  

It took me about two months to see a consistent improvement.  Now I feel much better (on only a 50mg dose) - I don't know if it is the Provigil or if that region of my brain has healed - but I don't want to stop taking the Provigil because it took so long to feel normal!

So hang in there.  The good news is that it is working!  Cheers, Jules
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