Today I found out that my Medicare Part D insurance carrier has changed the drug Provigil from a tier two to a tier three drug. That means that instead of the $38 I paid last year, I now have to pay over $90. I am flabbergasted, especially since that drug is due to go generic next year.

Has anybody else had this happen to their Provigil Rx? Is there anything that is generic that can be used instead of Provigil? I simply can’t afford the $90, and I do qualify for state assistance, but it is no longer their enrollment period.

Dag nabit!

I would say something but it would be political in nature.

Can't help with your problem with Provigil.

It is not unusual for copays to change tiers. It is the insurance's way to force you to try Ritalin generic for example for the same purpose. (or amphetamine).

This link explains the complex issue of generic availability and
when it may occur now (delayed) in 2012.
http://en.wikipedia.org/wiki/Modafinil
(scroll down near the bottom).

ProVigil is horrendously overpriced...I mean really...for what you get. This inflated price is what is driving the tier change for you.

I have a heart murmur, so I can't take anything that'll over tax my heart. Provigil didn't change my BP a bit, but any form of amphetamine would. I'll have to check out Ritalin. I just got a new PCP this week. Looks like he's got his work cut out for him.

If you can prove this, then you may make a claim to your insurance and they may waive the extra cost.

Typically your doctor would have to fax data to them, etc.
Check with them for this procedure.

There is no guarantee that ProVigil will work for you however.
It can fail.

FYI

Yet another way we as consumers of a necessary prescription medication get bent over by the pharmaceutical companies...

there is more to the slimy story if you go to the NYT link posted above.

http://www.nytimes.com/2010/01/07/bu.../07jetlag.html

"Provigil will face generic competition in April 2012 under terms of an agreement Cephalon made with several generic drug manufacturers. The Federal Trade Commission has sued Cephalon, saying it paid off those generic manufacturers to delay the advent of competition.
Cephalon, which denies the charges, is trying to shift patients from Provigil, also known as modafinil, to the very similar but slightly longer-acting Nuvigil, or armodafinil. Nuvigil has patent protection until 2024, although generic drug companies are already moving to challenge those patents.
To get patients to shift, Cephalon has raised the wholesale price of Provigil to $13.60, from about $5.50 a pill five years ago, including a 29 percent increase in November. So Provigil is now 50 percent more expensive than Nuvigil."

Okay, I'll get political.
Even though I voted for and worked for Obama for pres., I am so upset about this so-called "health care reform." Pul-ease.
The patient continues to get jerked around by the insurance/pharm combine...and the reforms don't answer this problem at all...

Mom takes a hormone pill for breast cancer. It isn't covered by hers either. She will have to pay $75 a month for one more year. She used to get it free from the oncologist but since she moved up here, no deal. She was in a trial.

I don't understand. She must take it. The success rate after five years is very high taking this drug. Oh well, can't do much about it. She has to have it. The worst part? She doesn't want to pay and thinks she doesn't need it.

I was refused this Rx, because its cost would put me over my alloted cap for per monthly fees. It was quite the struggle, and the neuro worked hard, but was told, NOPE! and they suggested I drink a cup of coffee instead. OMG! insurance companies are rude! Its horrible when your MD says you need something, and an non medical person can say ...nope, its too pricey.

I would call the NMSS and knock on other doors. Go down swinging.

Coffee...be careful, some pharm might try to make caffeine a drug and sell it...
makes you want to poke your head out the window like the movie "Network" and say, "I'm mad as hell, and I'm not going to take this anymore..."