Hi all! I'm new to NN and Narcolepsy in general. I was diagnosed in March and it really blindsided me. I didn't (and still don't) know much about N, but I never in my wildest dreams would have thought it was causing my extreme sleepiness.
In addition to this shock, I'm having a lot of trouble getting any prescription covered by my insurance. I'm covered by Anthem Blue Cross Blue Shield in Indiana and my contract has a benefit exclusion that prohibits coverage for anything they deem "mental health." Conveniently for them, they have categorized literally every medication that is commonly prescribed for Narcolepsy under the umbrella of "mental health." In my opinion, this is severely inaccurate, but that's a discussion for another post entirely. They won't even cover generic Methylphenidate or Modafinil, which are both listed as Tier 1 drugs in my formulary. I find it funny that they covered more than half of my sleep test, but once I'm actually diagnosed with something and need treatment, they pull coverage.
I tried a two-week sample of NuVigil, but didn't see drastic results so my doctor wanted to prescribe me the higher dose. This is when we found out it wouldn't be covered. We tried doing a prior authorization but they wouldn't even review it because of this benefit exclusion. My doctor sent in an appeal this week, so I'm waiting to hear my fate. Until then, I payed the full price for Methylphenidate because it was the least expensive to buy not covered and my doctor wanted me to be on something. I've been on it for two weeks and am less than thrilled by the results. It's very inconsistent and I'm lucky if it keeps me awake for the full 4 hours per dose.
Has anyone else run into this ridiculous "mental health" issue? If so, how did you work your way around it? What meds were you able to get covered? This has been extremely frustrating and defeating and I hate it that the insurance company has the power to tell me and my doctor was is medically necessary.