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Insurance won't pay for Provigil


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#1 ELLE

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Posted 27 December 2007 - 10:46 AM

Has anybody else had a hard time getting their prescription for Provigil covered by insurance? I've jumped through all the hoops, yet they still deny my claim. I can't afford to pay for it out of pocket, as it's very expensive. Lastly, does it really help? I would hate to fight to get it if it's not worthwhile to do so.

#2 Drea

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Posted 05 January 2008 - 11:06 PM

I do take provigil and seems to be helping me. I had a lot of problems trying to get it at first to. My insurance company made me take redlin at first, and even then I had to fight for the provigil. I know how frustrating it can be, but don't give up becuase this is the best medication I've tried that works, and it is worth it!

#3 turkt

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Posted 12 February 2008 - 04:14 AM

Get your doctor to give you some samples. Try the Provigil web site.
You can get your Dr. to fill out the Rx for a free trial coupon.

#4 Lais02

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Posted 13 February 2008 - 12:05 AM

I started taking Provigil in August. My family was skeptical and asked if I could even tell a difference. I replied, "I can't believe how much better it is, I had forgotten what it felt like to be awake!"

I think it works wonderfully. I also had a hard time to get my insurance to cover it. In the end it was covered, because there is no generic form and I had already tried Ritalin.

Good luck to you! It is worth it to keep trying.

#5 Julie

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Posted 08 June 2008 - 07:54 AM

You can call the number on the provigil website to speak with someone. The company
will send samples to you doctor if he will fill out some forms. The number is 1-800-675-8415.. The company will also send forms and help you try to get you med paid for. I found this out after I bought the first prescription. Julie

#6 maryluz2

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Posted 21 August 2008 - 10:36 AM

At the beginning I had the same problem with my insurance, but my doctor sent them a letter stating that was very important for me to start taking Provigil; however, still I had to pay arounf $50 / month for the medication. Today I am going to start with Xyrem, e'll see who it goes.

#7 MaliEinen

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Posted 21 August 2008 - 04:34 PM

What is the reason they are siting for the denial of Provigil? They must have a reason.. if you know the reason, you can make the rebuttal. Some insurance requires that you have tried other cheaper drugs and "failed" at them. Other insurance will reject coverage until they get a copy of your sleep study that diagnosed narcolepsy before they will approve. Ask your doctor to complete a "Prior Authorization"

#8 lc2031

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Posted 21 August 2008 - 09:28 PM

It's absolutely worth the fight.
What grounds are they basing their denial? Is your insurance through your employer? Is it self-funded (ask your benefit manager)? What state is it purchased in? Do you have a deductible that you haven't met? Ask the insurance company to direct you specifically (page and paragraph) to the part of your policy they are using to deny the claim. Happy to help, but need more info to actually be helpful.

#9 sleepybrown

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Posted 05 September 2008 - 09:53 AM

I absolutely had to go through that mess not so long ago when I changed to a private policy. It was crazy because I have been on Provigil for 7 or 8 years. For my provider the problem was that I had not ever been on an amphetamine. They told me that I should try those first. The girl on the phone had the nerve to try to convince me that it would be much cheaper and thus a better fit for me anyway. I was lucky that my doctor went to bat for me and got it covered. Provigil works but it all depends on how hard you sleep. Really it is supposed to make sure that you feel the sleep coming on as my doc explained it as opposed to knocking you out. The only problem I ever really have with that is if you try to fight the sleep when you feel it coming. That is just asking for some social akwardness.

One thing though, if you are still in the middle of your battle for coverage make sure you keep the labels and receipts for the perscriptions you bought at full price and when the insurance does cover it get your money back from the provider. It also helps to call the different drugstores and grocers and ask how much their pharmacy charges because it can be a difference of up to $25, or it was in Virginia at least.
QUOTE (ELLE @ Dec 27 2007, 04:46 PM) <{POST_SNAPBACK}>
Has anybody else had a hard time getting their prescription for Provigil covered by insurance? I've jumped through all the hoops, yet they still deny my claim. I can't afford to pay for it out of pocket, as it's very expensive. Lastly, does it really help? I would hate to fight to get it if it's not worthwhile to do so.