Re: Nuvigil/insurance payment problems/Janet

[Guest guest]

>Janet wrote:

>

> If anyone knows of a way to get around this prescription blocking from the

insurance company, please let me know. I have had the tests required by them

and I have the physician's letter, is there anything else that can be done?

Janet:

Call your insurance company and ask to speak to a case manager. Ask her what is

the justification for being prescribed, Provigil, or Nuvigil.

Explain that you do have Narcolepsy, do not include the chronic pain aspect as

they seem not to pay if they think it is off brand use for sedation from opioids

as that is not included in manufacturer usage.

Provigil is going to lose its specific patent in 2012 and go generic and be

cheaper. My insurance company required that :

1=Sleep evaluation 2. Sleep Study 3. Diagnosis from Sleep Specialist 4. Sleep

Survey done (just question survey) 5. Using CPAP

They just require two out of five of these to pay and have a justification form

that we fill out annually. Doing a letter about well being and other things they

could care less but they refused the first justification when my Doctor stated

it was for the usage to off set excessive sleepiness from opioids.

That was an instant denial. You need to speak directly with your insurance

company or pharmacy contractor for your insurance, mine is Express Script.

Learn key words to get you meds such as override, justification etc. The

pharmacy company will tell you about what they consider and justification

needed.

My insurance company has a formulary meeting quarterly and things change,

medications are dropped and added so keep up with it. Call yourself and ask to

speak to the Supervisor, keep their fax number, phone number, and instructions

written down and remember their name so you can reference it if a problem

I have had to do this and it is smooth now but every year, we have to call and

in five minutes I am approved for another year. It took finding the right

combination, the right form, and right person. Study your insurance formulary

and requirements for off brand usage and good luck.

Bennie

*In the meantime, call the manufacturer for the pharmacy assistance program for

patients and talk to a specific person to assist you for free medications until

you can get this resolved.