Tips for Provigil/Nuvigil Approval???

[Lulu54]

A co-worker called this week with a question about our insurance - she was denied provigil/nuvigil, even though her doctor contacted the insurance company and appealed the decision.  She suffers great fatigue and the sample helped her a lot.  She was wondering if I had any clues as to how others get this drug approved since it is not an MS drug.

I suggested it needs to be done under the results  of a sleep study since it is a narcolepsy/sleep deprivation drug-am I making that up or did someone here have to do that to get this drug approved?

Any tips you might have, especially dealing with blue cross insurance is appreciated.

best, Lulu

[SherB852]

I have had my doctor resubmit the prior authorization and request for the Nuvigil because her first submission was so not right.  No wonder it was denied.  I called my insurance company and asked exactly what did they need.  They said we could do a new request and they told me all the details.  I gave those to my doctor and told her they said to be very thorough.  I hope she does what I asked because I gave her all the info she needed.  I am waiting to see how it turns out.

In the meantime, I have found a nice discount with GoodRx.  They have Nuvigil coupons for both 150 mg and 250 mg.  Both coupons show about $536.  I even checked with my pharmacy and they said that is correct.  Tell your doctor what your plan is.  Even if you are taking 150 mg ask him/her to prescribe 250 mg.  This way you can cut your pills in half and they will last two months.  So here is where the savings is.  Rather than $536 for one month, it comes to $268 a month.  

Also, go to the Nuvigil.com website.  You can get a discount card for one month free of Nuvigil and refills will be $50 off retail.  That $50 doesn’t help a lot, but getting one month free is nice.  I did that.  I won't get the refills with that card but I plan to use Good Rx if I don't get approved for insurance coverage.

[Lulu54]

Hi, SherB852- you may not have noticed this is an older conversation and topgun asked that question last year.  Thanks for trying to help with this- getting some of these drugs for fatigue is incredibly frustrating.

The best recommendation I can make to everyone trying to get this type of drug is to have a sleep study done.  The insurance companyies will approve its use if there is a documented sleep problem.

If you can't get the provigil/nuvigil approved, since it is considered off label use for MS, you might talk with your physician about other drugs that might help, in particular the drugs prescribed for attention deficit disorder.

[SherB852]

Unfortunately, you cannot get Provigil/Modafinil or Nuvigil from any reputable Canada pharmacy.  I am looking into any costs savings available now since my appeal for coverage was denied by my insurance company.  I will post again soon when I have more options to share.

[topgun1050]

Hi.  I just lost my health insurance and waiting for COBRA, however I know Provigil or even generic Modafinil will be outrageously expensive.

Where do you buy Provigil or generic in Canada?  This happened to me once before.  I was spending around $800 or $1k on 1-30 supply of Provigil.  I was running up credit card bills.  My doctors did the best they could to get me free samples, etc.  Im at my last straw to finding a random site and ordering online and crossing my fingers my credit card does not get compromised.

Anyone?

[Lulu54]

Hi Linzr and cyberersal and medgreeddisgust -

thanks for adding to this conversation based on your own experiences.  Since Provigil went generic, I have been taking modafinil -  there are days I try to not take the pill and I find by about 3 pm or so, I really just want to put my head down on my desk and sleep.  This, of course, is not an option, so I go back to taking the modafinil and it does make a difference.

I hope that the situation with getting this approved will get better soon - so many of you would do better with the fatigue if you were able to take this pill.

[LinzR32]

I work in a retail pharmacy and am used to seeing the prior authorization responses from insurance companies. I also used to be on Provigil (brand) and now take the generic for it, Modafinil, and my insurance approves it, but I have had a sleep study with a narcolepsy diagnosis and my doctor's office has to get it approved every year for a one year period. It is not easy and the doctor has to be willing to fight to get the approval. The diagnosis does make a difference. Without my narcolepsy diagnosis I would be denied for this medication. I do the same with generic Adderall XR and generic Ritalin.