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Insurance Will Not Cover Provigil

After getting the run around for months, my insurance company has now denied payment for Provigil.  They refuse because using Provigil for MS fatigue is an "off the label" use for the medication.  Any advice???
7 Responses
572651 tn?1530999357
How proactive does your doctor want to be on your behalf?  Any drug can be waived for coverage by insurance even if it is off label use if the doctor can present the solid argument.  I am currently trying flowmax for my bladder problems - it is definitely off label use for me since I am neither male nor do I have problems with my prostate.  I was originally denied this drug because it is only for males but my urogyno went to bat for me and about a week later it was approved for me.  I would contact your doctor office and ask for their help.  Good luck, Lulu
333021 tn?1207759633
Hi

I was rx.ed Provigil but my insurance denied me too.    They did accept Ritalin , I've been on it a week .. It helped a little with the fatigue but I was being cautious , I never took a full dose ( I'm sensitive to many drugs)  I see neuro tomorrow and am going to try to get Adderall instead , its suppose to have a smoother effect.

Good luck

Jo
147426 tn?1317265632
Lulu gave you the straight scoop.  Your insurance plan has a process for appealing such a denial.  You will need your doctor to write up something on your behalf.  So call the insurance Ombudsman or whomever, and see what the advanced appeal process is like.  I am on Medicare and my Provigil is paid for.

If need be we can look for the medical literature articles which mention and promote it's use.  It may be the only way some people with MS can continue working.

Quix
Avatar universal
Thank you for your quick responses.  For the past months I would probably have benefited from an increased dosage of Provigil, but I dared not double the dose because it would also double the cost.  I have opted to take the 100 mg, drink two cups of coffee, and take a nap as soon as I get home from work.  I feel guilty enough as it is . . . three kids (two of them teens) and I am pulling from the family budget just to stay awake.  Just an hour ago I told my husband that without the Provigil, I'm afraid I cannot continue working.

Sorry about the whining . . . it just came bubbling out.  I will definetly appeal and may be seeking your guidance along the way.

Thanks,

Sherry  
572651 tn?1530999357
Sherry, You are not whining , just vocalizing your concerns and needs ! :-)    Its such a tough choice when you have to pick paying for drugs and paying for other family needs.  Please consider yourself a family essential and that every penny spent on keeping you active is well spent.  you know where to reach us if you need more help!  my best to you, Lulu
Avatar universal
You should definitely pursue this!

My Neuro #1 wrote my first script for Provigil, although at the time, he could not diagnose a neurological illness.  

We did discuss my "excessive daytime sleepiness" though.

I had been diagnosed 15 years prior at Johns Hopkins w/ Chronic Fatigue Syndrome.

Two years later I was diagnosed with Fibromyalgia at Mayo Clinic.  

I think the literature on Provigil says it is most often used to treat Narcolepsy and also used for those who do shift work.  Interestingly, I also read that it is used during combat in the Military.

A few months ago I went through the appeal process to get my insurance to approve Lyrica.  Basically, after a few phones calls and having my Doctor fill out a short questionaire -  I was approved.  Unfortunately, it  turned out that I could not handle the side effects and stopped taking it altogether.  : (

I totally understand your frustration and hope you can get this resolved.  Also, I would shoot for 200 mg/day - you can always cut back if you need to!

Good luck and best wishes,
Julia



,
Avatar universal
Yes to what everyone else is saying.  My neuro is willing to fight for anything and everything on my behalf.  Your doctor should be your first advocate.  And you can ask your doctor for as many "samples" as possible.  I'm on the 200mg sample which I cut down to 100mg and now down to 50mg.  I called the 1-800 number for the medication to ask and had a nice time talking in circles to the patient rep.  The pill is scored so it technically can be cut.  And cutting the pill does not affect the method in which it is absorbed into your body.  (I wish to point out though that I am talking smaller doses because I am having heart palpitations at the 200mg, 150mg, 100mg dose.  I'm currently trying around a 50-75mg dose and will be seeing a cardiologist at my neuros request.)  I've tried some other medications and had horrible reactions so Provigil is my only option.  Good Luck, Jules
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