Posted by softheprairie on July 24, 2009, at 4:49:10
In reply to Will Medicare cover Provigil w/o documentation?, posted by JayBTV2 on July 22, 2009, at 11:52:17
It might be easiest to have a sleep study done to see if you do have sleep apnea -- it would be a convenient coincidence if you do. Lots of people have it and don't realize they do.
But if you don't have sleep apnea, narcolepsy, nor shift work sleep disorder, you could face a real challenge, but there is some hope, in that you have a choice in which Part D carrier you go with. Each state has a program of free counseling to help with your Medicare questions. They have "Senior" in their names, but I still got assistance from them as I have Medicare due to disability and am in my 30s. Here is a link that lists the contacts by state: http://www.quickbrochures.net/medicare/state-health-insurance-assistance-programs.htm .
You might have to go to the Medicare webpage and go to the section where you enter your meds and it tells you which Plan D companies cover those. But, the results of that search are just the starting point. They may only cover them in limited circumstances. You may have to call or search the websites of several different Plan D carriers to find out their exact requirements regarding Provigil.
A side note: I remember reading on CrazyMeds that the company that makes Provigil only gives it for free to poor folks for whom it is on-label (people who have the sleep apnea, narcolepsy, or shift work sleep disorder --not sure if I'm labeling the last one correctly, but the name of the condition is something like that).
I know coverage of Provigil was definitely a part of which Plan D program I picked. I'm not on it, and have never tried it, but I'm quite interested in it as a possibility for the future. I am "lucky" in the sense that I do have sleep apnea, so I could get it on-label, potentially. I ended up picking SilverScript as my Plan D carrier for the time being. They do limit Provigil to on-label use. However, I do know I have read they have a policy on off-label coverage where they GENERALLY cover meds off-label if one of their listed reference books/compendia has written about it as being sensible to try for a specified condition off-label. I'm not sure which policy trumps if one of those books does say it is sensible to try Provigil for ADHD -- that "compendia" part or the specific note about limitation of coverage for Provigil.> Hello,
>
> If my pDoc writes me a prescription for Provigil will Medicare need documentation saying it's for Sleep Apnea in order to cover it?
>
> Basically I'm ADD and I've tried a bunch of the standard stimulants (Adderall/Ritalin/etc) but they give me chest discomfort/heartburn. I've taken Provigil before but I was paying out of pocket...
>
> At the moment, If my insurance won't cover Provigil there's no way I can afford it. It is listed on my insurance's website (www.aarpmedicarerx.com) but I'm not sure if they'll request info from my doctor (since it's so expensive and only approved for sleep issues. My doc would be writing the script for off-label ADD/Depression.
>
> I appreciate any info....
>
> -Jay
poster:softheprairie
thread:907919
URL: http://www.dr-bob.org/babble/20090721/msgs/908304.html