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#1 jlconrad

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Posted 07 December 2007 - 02:18 PM

I just switched to anthem insurance because of work and they won't cover more than 200 mg for me. I have been taking 300 mg for almost 6 years now and it works great, but they don't seem to want to cover it. I have a sleep study and records but apparantly they won't cover me. I am wondering if anyone else has had this problem and if so what you had to do to deal with the situation? Any advice would be much appreciated. Thanks!

#2 WakeChallenged

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Posted 09 December 2007 - 03:39 AM

My sleep doctor told me that some insurance companies will only cover 200mg because when Provigil was being tested, apparently 200mg was the dosage that seemed to work well for "most" of the people in the trial studies. However, as you are aware (by taking 300mg), that is not the case for everyone with Narcolepsy. After several times of adjusting my medication, I was put on 600mg of Provigil and my sleep doctor told me if I had any problems from the insurance company to let her know because sometimes the doctors can write letters or work with the insurance companies so they will approve the dosage. I did not have any problems with my insurance company as far as approving or filling the prescription.

Talk to your doctor and ask him/her to work with the insurance company on your behalf to get the dosage you need. If that does not work, maybe your doctor could prescribe something else to go along with the Provigil. After a while, I could not take 600mg of Provigil because it made my migraines worse, so my doctor adjusted my meds to 400mg Provigil and 60mg Adderall per day. This works better for me, but I still have major sleep attacks in the afternoon.

Good Luck!

#3 Cryopathic

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Posted 15 April 2008 - 01:48 PM

Whats Adderall?



#4 sleepyavon

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Posted 15 April 2008 - 10:12 PM

QUOTE (Cryopathic @ Apr 15 2008, 12:48 PM) <{POST_SNAPBACK}>
Whats Adderall?

It is a schedule 2 Methamphetamine Prescription CNS stimulant, typically use in ADD... my sister takes it. I am on Provigil, because I have a heart condition which is easily aggitated by stimulant medications.

#5 Cryopathic

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Posted 16 April 2008 - 01:02 PM

Oh mellow.gif

#6 Kimberly

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Posted 30 April 2008 - 09:49 PM

Call the customer service number on the back of your health insurance card (or prescription card) and ask what the procedure is for getting an override or prior authorization because your prescribed dosage of a drug exceeds their standard approval levels. If they deny you, appeal. If you appeal once and are denied, appeal again. Exhaust your appeal process and if they still deny you, file a complaint with your state's Department of Insurance.

QUOTE (jlconrad @ Dec 7 2007, 01:18 PM) <{POST_SNAPBACK}>
I just switched to anthem insurance because of work and they won't cover more than 200 mg for me. I have been taking 300 mg for almost 6 years now and it works great, but they don't seem to want to cover it. I have a sleep study and records but apparantly they won't cover me. I am wondering if anyone else has had this problem and if so what you had to do to deal with the situation? Any advice would be much appreciated. Thanks!


#7 sarahlue

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Posted 01 August 2008 - 09:08 PM

I had the same sort of issue with my insurance coverage. My doctor told me it wouldn't be a problem though and he would take care of it. When I asked him how, he said he would be very persuasive and let the insurance company know that if I was not allowed the dosage that I need and if I was in an accident or something to that nature then it would end up costing the insurance company more. A week later my dosage was approved. I would suggest asking your doctor to do the same. Hope this helps!

Sarahlue