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Insurance won't cover Provigil use for HD symptoms

Posted by TylerFitz 
Insurance won't cover Provigil use for HD symptoms
March 29, 2012 01:39PM
For a couple years now, I have been getting generic provigil by way of India (Sun Manufacturing's "Modalert"winking smiley and it appears that we may see more generic modafinil (Provigil) access in the USA in the next few days. If I am reading some news correctly, Provigil (Cephalon) had successfully bought off every generic mfr in recent years to corner the North American market. Teva bought Cephalon, but that probably has no impact.

Alas, April 1 is nearly here, and I am hoping to find more of the internet pharamacies freely selling the provigil products. Why is this important? Because my Rx insurance (Caremark/CVS) won't cover the Provigil for my wife because HD is not an acceptable off-label use. They have three acceptable conditions... including narcoplepsy and swing shift disorder... but, once again, HD gets no love or respect from these insurers in the "prior authorization" review.

A (30) day supply of Provigil through Walgreens today would cost me $1000 without insurance picking it up. Just wondering if anyone else has been following this and experiencing similar angst?

Thanks



Edited 1 time(s). Last edit at 03/29/2012 01:39PM by TylerFitz.
Re: Insurance won't cover Provigil use for HD symptoms
March 29, 2012 05:00PM
hmmm...i have never heard of this med, so i just googled it, and it looks very interesting. Anyways, wikipedia says the US FDA also approves it for sleepiness from sleep apnea. Does your wife have a bad snoring problem at all? If she does, maybe she could get diagnosed with sleep apnea, and get it covered that way
Re: Insurance won't cover Provigil use for HD symptoms
March 30, 2012 10:27AM
I've been using Modalert from India for several years now. I had a prescription for Provigil 200mg #90 and went to WalMart yesterday and checked on the price - they wanted $2,100 for a 90 day supply. It is simply outrageous. $23+ a pill. so I have to go onto the internet and find it through pharmacies that I have no idea if it is reliable or if it is the right drug?

What internet pharmacy do you use to purchase Modalert?

thanks...
rm
Re: Insurance won't cover Provigil use for HD symptoms
March 30, 2012 01:28PM
@Barb, I'm surprised you haven't heard of this medication before, but maybe it's more commonly used in Europe than in the US. According to the info I got from our neurologist, it not only enhances alertness and vigilance, it is also beneficial in improving memory and concentration.

Both my HD+ husband and daughter have been prescribed Modiodal (the European brand name of provigil). In my daughters case it's been a great success since she's tried Straterra and Ritalin in the past before we knew she had HD. Both of these drugs had severe side effects like tremors and tics, but with Modiodal she hasn't experienced any of these problems.

I'm shocked to hear the cost of the drug in the US, it's outrageous that it has to be so expensive. The price before subsidies is $116 for 30 pills here in Denmark, but last time I picked up a prescription at the pharmacy I only paid around $20 for a months supply.
Re: Insurance won't cover Provigil use for HD symptoms
March 30, 2012 03:15PM
These are all examples of how corrupt our system is in the US. Before tetrabenazyne was approved by the FDA it could be purchased from Canadien Pharmacies for about $150 per month. Since it was approved in the US and rebranded as xenazine the price has skyrocketed. Last month my daughter's one month supply rose $700 to $5400 per month. It has to be purchased from Accredo Pharmacy, the mail order company contracted to dispense it. This is why medicare/medicaid is broke. This is the fraud that should be stopped. Did you ever check how many congressman and senators (both Democrats & Republicans) own shares in these drug companies? You would be appalled. This is legalized fraud and is denying the poor folks who need help most.
Re: Insurance won't cover Provigil use for HD symptoms
March 30, 2012 09:18PM
We had the same problem with provigil and other medications. Turned out it was a matter of how the script is written. Given that the medications are not approved as effective treatment for HD the insurance does not cover. However, we were able to get it approved when the doctor wrote the script for the symptom as diagnosis... not huntington's as the diagnosis. example: depression, muscle rigidity, dystonia, or any of the symptoms have their own seperate diagnosis so that specific symptom can be used as the diagnosis since the medication is being used for that "illness." This has worked for us for over 7 years.... Good Luck

Stacy
Re: Insurance won't cover Provigil use for HD symptoms
April 04, 2012 07:55AM
Stacy, the problem that we have is that unless the neurologist were to somehow write the script for Provigil (or Nuvigil), it would have to explicitly state work shift disorder, sleep apnea, or narcolepsy. I don't believe the symptoms alone would get these stingy people at Caremark/CVS to approve coverage. They really try to shake you down with the PA (prior approval).

As a matter of fact, the irony is that I will be getting Nuvigil, most likely for swing shift sleep disorder, for doing more night driving with my job, to minimize my overnight stays. So insurance would cover for me, but not for my wife with HD. That is just insane.

I also see that Provigil generic is more available now on the internet, but I am not familiar with that generic version which is mfr'd by Signature under the name Modavigil. We have had good luck with Sun's Modalert. The problem is that edandmore (dot com) no longer accepts Visa and requires a money order. That is not in our best interest and suggests that the outfit might be going under, take your money, but not ship your product. It has warning flags all over it.

Good luck.


stacyw Wrote:
-------------------------------------------------------
> We had the same problem with provigil and other
> medications. Turned out it was a matter of how
> the script is written. Given that the medications
> are not approved as effective treatment for HD the
> insurance does not cover. However, we were able
> to get it approved when the doctor wrote the
> script for the symptom as diagnosis... not
> huntington's as the diagnosis. example:
> depression, muscle rigidity, dystonia, or any of
> the symptoms have their own seperate diagnosis so
> that specific symptom can be used as the diagnosis
> since the medication is being used for that
> "illness." This has worked for us for over 7
> years.... Good Luck
>
> Stacy



Edited 1 time(s). Last edit at 04/09/2012 11:21AM by TylerFitz.
Re: Insurance won't cover Provigil use for HD symptoms
January 21, 2013 01:11PM
Hi,

I just wanted to share my recent (today at lunch) experence with Provigil.

I belong to Costco and use their pharmacy. I have a prescription for Provigil 200mg quantity 180.

My jaw dropped when I saw the total without my insurance.

A little over $7100.00 for a three month supply!

Something really needs to be done in this country to stop this insanity.

I wonder if this could be the reason the drug is so expensive?

[articles.philly.com]

We all know who pays for that!
Re: Insurance won't cover Provigil use for HD symptoms
September 06, 2013 06:03PM
what?



Edited 5 time(s). Last edit at 02/19/2015 10:09PM by derrens.
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