This medication is INSANELY overpriced.

I think it started out this way because of the limited FDA approval.

Then they tried to get a child's version approved for ADHD, and that bombed out too.

This is an interesting monograph.

http://en.wikipedia.org/wiki/Modafinil

I'm taking generic Ritalin because Provigil stopped working for me. The Ritalin works for me. I know Snoopy is taking an ADHD type of stimulant drug with success, too. Maybe ask about that.

dej - I would fight this - or rather, have the neuro and pharmacy fight it for you. I was told by my pharmacist that if my doctor says a medicine is medically necessary for my condition, that the insurance company HAS to pay for it.

I take provigil daily - 200-400mg as needed.

I also use a patch from time to time. It is an ADD medicine called Daytrana. A psychiatrist I work with mentioned it to me - that it might be helpful for fatigue and it would be better than any pill because it is a patch, it is a consistent flow in the bloodstream. I told my neuro about it and he gladly prescribed it for me to try. I wear it for 9 hrs during the day, then take it off. There was a period of time - before I did HiCy where I could NOT survive a day without it! Maybe your neuro would consider this?

Also, does your neuro not have samples of Provigil or Nuvigil for you to try? Nuvigil is the new provigil, as someone else here mentioned. My doc also gave me samples of Nu - and a coupon for a free 30 day supply. If you'd like, I can mail you the coupon? All you would need is a prescription.

One other thought - if you have a rx, can't you go online and get it from a canadian pharm for dirt cheap???

Good luck,

~Keri

Spoke to the nuero who used up three appeals to the insurance company. All appeals were denied. Its an "off label" use to use it for MS patients. that was their final sticking point. My neuro told me that he has now spent a great deal of time, and effort on this, and he simply cannot spend 6 hours a day fighting with these insane folks. He has his nurse continuing to peck away at them, but thus far they are not budging. They are also saying to add provigal would put me over my alloted monthly allowed expense for medicines. I have a golden policy, and it covers many things, but lately they have been real pigs about many things. They have demanded that if you use brand name vs generics, your MD must sign a paper certifying that this is absolutely needed, and not just a patient preference. Many thyroid meds of generic wont work as well as brand name, same for some cholesterol meds, and others but the insurance company must certify in advance that you need this to be brand name EACH MONTH!

This is insane to have this wonderful policy and now have so many restrictions upon it. I used to have 10k per month allowed in medications. now its 5k, but they removed the 3 million dollar limit that was placed on it. So, they made it better, but they also made it worse. They fight you on everything from epi pens to brand names, to off label useage of meds. Its insane that my MD cant say he wants to give me xyz, and have them order it. Even if its 10cents or 10thousand.

Sheesh, everyone talks about how there will be no beaurocrat between you and your MD...there is already a beaurocrat sitting there! Since they already exist I know that to be an untrue statement. If I need surgery, or an in office proceedure, it has to be pre certified! my MD cant simply say "you need your tonsils out" he has to call 20 people and fill out 3 days of paperwork before he can even offer that as an option. They even wanted to know why I was seeing him for a neuro visit when I am considered to be a patient of another clinic. Sheesh!

My MD said he simply cannot continue to peck away at these folks, and that is what they hope for. They hope that they make it so inconvienent to keep fighting that the MD simply gives up. The appeals process is insanely complicated as well. He was turned down for 2 appeals because they didnt feel he met the proper paperwork requirements for "burden of proof" If this was insulin or chemo, we would keep fighting, but a med for fatigue? there are other avenues to try first. Then if we run out of road, we can revisit it.

Thanks for the support. :grouphug:

Yikes, they call that a golden plan? I'd hate to see what's allowed on their basic plan. :confused:

As an aside to this discussion and the whole insurance company fight thing, my last refill on Provigil, I had to have a prior authorization as usual for the year's prescription. Usually the doc sends in the paperwork and I get it.

This time it got held up repeatedly, despite me calling the insurance co. and having them call the pharmacy and help them to understand that I do NOT have "Wellpoint" or "Nextcare" or whatever the heck they were talking about when they said repeatedly that those entities were refusing to okay the scrip.

It eventually got worked out in my favor, but in the middle of it all, my co-pay changed and the co-pay was $40.00 dollars more.

I fought it. I insisted on an apology and that whomever was responsible for the screw-up be trained in how to bill my insurance company. Each party blamed the next and the only one I KNOW did everything correctly was my doc's office. I also asked for the $40.00 back on the co-pay.

I got a letter today from the insurance company with a check for $40.00 and an apology, along with a copy of the investigation letter and the apology from the pharmacy. The pharmacy investigation went all the way to the top of the chain and they say that they are putting in place an informational sheet that specifically explains how to bill for my insurance plan.

It DOES pay to make waves. I was just so glad to get the drug I almost gave up on fighting, but figured I had nothing to lose and I WON!!! :)

I am on Nuvigil (a new time released Provigil). It has helped me so much! The afternoon fatigue was unbearable. My insurance company now refuses to pay for it because it is not approved for MS. I don't know what to do. Does anyone have a resource for purchasing provigil at a discounted rate?
Thanks

Below is a link to Costco's website to see pricing. I don't know what strength and dose frequency that your rx was written for, but these are actual full prices without insurance.

http://www.costco.com/Pharmacy/frame...ticle=PROVIGIL


My idea would be for you to see if you can get a free sample from your doc first to see if it even helps you. I had one insurance company absolutely refuse to cover this drug, but my present company will cover it.


If this drug is completely out of the question for you, ask your doc about stimulants like Adderal or Ritalin. I actually have had better luck with Ritalin lately and it is generic and cheap.