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provigil & insurance questions

deleted_user
deleted_user
My rheumo gave me a script for my fibro fatigue, he gave me provigil.

When I went to pick it up one of the workers came out and told me that the insurance company needs prior authorization from the rheumo, he has to tell my insurance company why i need to take this, what its for, etc.

I looked it up and did not find anything negative about it. I have never had this problem, even with my narcotics.

What is the problem with the provogil that my insurance needs this info? I asked her if this was new and would happen everytime he switches me or puts me on something new, she said no its the provigil, but i couldnt ask her alot of questions as there were about 15 people in line and she came out to talk to me in front of all of them.

thank u
deleted_user
deleted_user
Wow that is really strange. Provigil is only a schedule IV controlled substance. I'm not sure what to say about that?
deleted_user
deleted_user
That's happening to a lot of people with different meds. My Mom goes through that to get Effexor XR. I think it has to do with price. Neither Effexor or Provigil has a generic.

I have severe GERD with esophageal damage and as of Jan 1, my prescription company will no longer supply it. I have to buy the over the counter version. It's ridiculous.
deleted_user
deleted_user
My only guess would be that maybe it's because it's considered a stimulant? At least that's what my doctor told me, of course he's the doctor that wouldn't prescribe it to me either. That's all I can think of. I'm fairly certain my son's ADD meds had to be approved thru the insurance company & the prescribing doctor.
deleted_user
deleted_user
I'm sure it has to do with the price,and it probably does not have a generic, so they want to see if they can get out of paying for it but seeing if your doc gave it to you for exactly what it's designed for, my insurance has done that to me several times,I swear their all crooks!
deleted_user
deleted_user
I still havent heard yet if they are going to cover this, but our insurance does not pay 100% of our scripts, we pay a % for each script we get.
I just wondered if there was something specific about this med, this is the first med that weve had to go thru the insurance like this.
Strange.
deleted_user
deleted_user
Provigil is authorized for people with sleep apnea, otherwise the doctor has to convince the insurance company that it is needed because each pill costs $9.
deleted_user
deleted_user
I agree dream, it's probably expensive with no generic. Let me know how this stuff works!!
deleted_user
deleted_user
I'm not sure why they would question the provigil. Unles it has something to do with other meds. Maybe they feel you don't need it? I took provigil for a while when I was on an anti-depressant,the name I cant think of right now, because it made me SO sleepy. The provigil merely gave me the energy to get through my day.
deleted_user
deleted_user
The reason the rheumo wants me on in it is because of my fibro fatigue. I cant even stay awake driving home from work. I have to talk to myself, roll the windows down, or call someone. Once im home from work I fall asleep sitting in the chair, of which never happens. I have no energy, i just want to sleep all the time.
He was supposed to have this taken care of by friday, I am going to call the office in the morning and find out.
deleted_user
deleted_user
I think that it's riduculous that our insurance companies have the right to question anything that our Dr's prescibed. If we have a prescription for it, we need it, end of subject. I have to fight with our insurance company all the time and I just don't think that it's right.
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