This Is MS Multiple Sclerosis Community: Knowledge & Support

Has anyone had their insurance refuse to pay for Provigil?

Mine has and Dr is calling to try to get them to pay.

CF

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Holly - Shine On You Crazy Diamond - Pink Floyd

9/3/09 Stanford - Dr Dake - Stent in R-J to unblock Arachnoid Cyst in Sigmoid Sinus. Stent in narrowed L-J. Balloon in narrowing where R & L Jugulars meet.

Hi Catfreak...
Provigil is still considered off label for MS, (it's a narcolepsy drug) so have your doc be VERY careful with language in requesting insurance. My husband's neuro's request to his insurance was denied for MS fatigue, but I called in, wrote a letter and cleared it up. The insurance co. accepted his appeal for "extreme daytime fatigue and depression related to fatigue." If your doc submits an insurance request for MS fatigue, it will be denied. I know, it's crazy, but what else is new?
Hope this helps-
AC

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Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
dual stents placed 5/09
CCSVI in MS

Blue Cross refused to pay for it when my neuro prescribed it for me. I have since seen many people claim that it helped for a few months/weeks and then did nothing, so I haven't felt deprived.

gwa

Cheer and GWA,

When I called the Dr office to tell them my Ins would not pay they said this is very common.

They will call and if Aetna (ugh!!) says no then they will submit the request in writing.

I may call them back tomorrow and ask how they approach the Ins Co. I pay a ridiculous amount for my health insurance and it's just not fair.

CF

_________________
Holly - Shine On You Crazy Diamond - Pink Floyd

9/3/09 Stanford - Dr Dake - Stent in R-J to unblock Arachnoid Cyst in Sigmoid Sinus. Stent in narrowed L-J. Balloon in narrowing where R & L Jugulars meet.

Provigil is a very expensive med and I can see why the insurance company could care less if a person takes something to not be so tired all the time.

Now I don't mind being so tired because I got a maid and my husband does most of the cooking and washing since he retired.

gwa

GWA,

I'm glad your hubby helps and you have a maid. You are very blessed.

I have to work for insurance and they dictate what I can and cannot do. I think it is a vicious cycle. Work for ins, work and ms me so tired, dr says don't work so hard, but then I would have no ins if I took a part time position verses full time and then would have no MS care or Meds. So I work for Ins.

My hubby help with dishes, laundry and our cats. I still work full time and cook and clean etc.....

CF

_________________
Holly - Shine On You Crazy Diamond - Pink Floyd

9/3/09 Stanford - Dr Dake - Stent in R-J to unblock Arachnoid Cyst in Sigmoid Sinus. Stent in narrowed L-J. Balloon in narrowing where R & L Jugulars meet.

Catfreak-
My husband was debilitated by fatigue....he actually had a car accident when he feel asleep at wheel, and he was unable to work. This was truly life-altering fatigue, and the provigil has been a blessing for him for the last year. He takes 100mg at 10am, and 100mg at 2pm and is able to function. He now works mainly at home, and is able to stay awake at his desk. It's not about being simply "tired"...it's about living. He has so much to offer in his profession, and cannot imagine retiring at 45. He still needs naps and rests, but does not fall asleep driving anymore.

When I wrote and explained his profound level of fatigue, his insurance (Blue Cross) reversed their decision, and agreed to pay. It may be worth it to you to follow up on this since you need to continue working.

Fatigue comes in all levels...and for some with MS, it is intolerable.
wishing you the best-
AC

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Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
dual stents placed 5/09
CCSVI in MS

This sounds like the type of person that Provigil is made for. It appears like he may also have narcolepsy.

I don't fall asleep, but have been very tired since diagnosis. It is not life threatening for me.

gwa

When I was younger, my life was very similar to yours. I worked full time even though I was exhausted and went home and cooked for a family of four.

My husband has always done a great deal of the house work even before I was diagnosed. Now that I am old and more decrepit, I am spoiled a little, but the trade off is that I am old and decrepit (and blessed).

gwa

i used it for about a yr it was a wonderful thing for being so very tired all the time. i however had to pay 95 dollars for a copay on it..now i started to throw a fit about having to pay that much but i found out how much the insurance was paying for it and i stopped complaining. The whole amount ended up being something like almost 550 for a month of pills... so i was happy to just pay the co pay..but it worked for me while i was on it.


chris

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waiting for answers

Initially mine refused but my Dr. intervened and its approved now.

I also have Blue Cross and my Prescrip was rejected. My Neuro now gives me the sample packs of 7 pills that his office gets from the drug companies. I don't need to take it every day.

You might want to tell them what's going on and ask for sample packs.

Voodoo,

Thanks for the suggestion. I will call and ask for samples.

CF

_________________
Holly - Shine On You Crazy Diamond - Pink Floyd

9/3/09 Stanford - Dr Dake - Stent in R-J to unblock Arachnoid Cyst in Sigmoid Sinus. Stent in narrowed L-J. Balloon in narrowing where R & L Jugulars meet.