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Medicare

  • By Faith French

    I’ve used Part D since 2006 and my med list has decreased to just 2. I evaluate policies yearly and end up choosing a new company each year. Today I wonder if I can survive their games. I resolve nothing between the Dr and insurance company.

    I’ve used Provigil since 6/2000. Ins denied it but covered it’s generic Nuvigil instead, which I’ve used since 1/2012. Each year we met the prior approval with the policy. This company has denied Nuvigil twice and Provigil once, so far.  I am paying out-of-pocket for Nuvigil every few days, in hope of approval. These drugs are often used as an anti-fatigue due to multiple sclerosis, but it is as an off-label use. I am concerned over my financial and physical costs. I saw new mental limitations from the beginning.

    How do I address this in a helpful way? Venting feels good. My story is minor, but with an elder unaware, and a critical medicine, it could evolve into a lost of life. MS does poorly with excess stress and I am proof of that.

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  • By Laura Kolaczkowski

    I had hoped with the release of generic modafinil, it would loosen up the insurance companies’ routine refusal of this off label use.  By any chance have you had a sleep study done? I have mild sleep apnea and my nejurologist was able to use that to justify my prescription for Provigil.

    I hope you can find a way to get them to cover this drug – for many of us it make a serious difference.

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  • By Faith French

    Heard from neuro office: it’s no go w/ins. Offered Ritalin which I refused. Can see if manufacturer can assist me to buy nuvigil, but that’s not 1st choice. I mentioned sleep study but they weren’t optimistic of it. I’m checking into a new ins policy. I’ll check further to their approved uses of  nuvigil before I buy. I will contact Medicare, etc., about that issue. I worry it is becoming more common due to economy.

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  • By DianeD

    I’m on Medicare and taking Nuvigil. No, Medicare doesn’t cover it ‘unless’ your neuro tells them it is necessary. I think they will cover Provigil, at least they used to. Unfortunately it’s all about money and Medicare only will cover the cheapest generic medications. This isn’t right, but it’s the sad fact that it isn’t about what works for us, but what they want to work. Of course that doesn’t help us.

    With all the changes in what is acceptable for us, I have the expectation that my neuro might not be able to get the Nuvigil okayed for me. I might not even be able to see the neuro I chose. These are uncertain times.

    Wishing you the best. Diane

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  • By DianeD

    Oops, I meant to mention sleep studies. I’ve had two. I found them pretty useless. It is really difficult for those who have sleep issues to fall asleep with wires everywhere. It was really uncomfortable; I didn’t fall asleep till around 6:00 a.m. right at the time they came in to unhook me and send me home.

    I don’t think they determined anything from it.

    Diane

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  • By talonsgirl

    I just recently got in Medicare and lost my Provigil because the Neurologist said it’s for MS fatigue, and nonow I’ve lost my Ampyra went from walking to wheelchair bound in 3 weeks. I get in one month of disibility of what I was making a week working as a nurse. Companies refuse to hire me because I have MS and they don’t want me on their insurance even though I am already on their insurance. I have a Master’s degree in Nursing Education and have not been able to get a job since I graduated….DO NOT TELL ME THERE IS NO DISCRIMINATION IN HIRING!!!!

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  • By Erin Rush Moderator

    I am sorry, talonsgirl. The healthcare system and the insurance industry (including disability insurance) are not perfect, by any means. While there SHOULDN’T be discrimination in the workplace, it would be unrealistic to say that there isn’t. Unfortunately, I know that quite a few of our members have had the same issue with their Provigil prescriptions. Please know you are not alone here. I am sorry potential employers aren’t able to look past the MS diagnosis and see what an educated, valuable person they are missing out on by not hiring you. Best, Erin, MultipleSclerosis.net Team Member.

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