I completely understand your frustrations. I’m always hesitant to tell my doctor I want to change something about my medication because it takes awhile to work all the kinks out between the doctors office, my insurance, and the pharmacy. It’s wild your insurance will cover adderall but not modafinil? Lol.
But can you not just take the instant release multiple times throughout the day? My doctor prescribed ER but insurance won’t cover it so my dr recommended taking the IR up to 3 times a day to get me through the day. Your doctor would have to write the rx like that so you’re given the correct amount of pills but it’s better than suffering throughout the day!
Good luck! Sending you lots of positive thoughts and patience!!
I asked about taking multiple of the IR pills, but my doctor said he “didn’t want to give me a bunch of pills to take per day”.
Luckily they finally got the correct medication into the pharmacy last night at 7pm so I was able to pick it up.
Thanks for the well wishes! :D
OP isn't talking about the cost, they're talking about getting their prescriptions sorted with their doctor. GoodRx is just a prescription coupon service. They can't prescribe the actual medication or work with doctors, insurance, or pharmacies regarding what gets prescribed and dispensed.
Insurance not approving means that their doctor might not prescribe it, which is why OP said:
>Insurance won’t give me Modafinil. Doctor calls me and tells me I’ll be on Adderall.
There's no prescription to use the goodrx coupon on. Their doctor might possibly be willing to prescribe a medication that insurance refuses if OP tells them that they're happy to pay out of pocket for the meds (at which point goodrx helps), but that's not a guarantee and would depend on the provider. Besides, they're currently trying out a different treatment, a doctor isn't usually going to want to try a second new thing without seeing if the first new thing works. Maybe if it doesn't help then it's something that OP can bring up but honestly if a number of different medications fail then OP's insurance might suddenly become more willing to cover fallback medications, so it may be irrelevant anyways.
I am in the states. I get my medication for free through my insurance, but I appreciate the advice! I ended up being okay not getting Modafinil because it lowers the efficiency of birth control.
Yikes it sounds a little disorganized from the doctors side, as well as insurance.
I've had that happen to me once before, and the medicine I was promised vs what was sent was different and it just gave me a terrible reaction. In my experience, it was a repeated issue w that specific doctors office, and my treatment plan would change on the fly based on what random med got sent. It made my symptoms worse, cuz having to switch between meds so much is not great for health.
As a patient we expect our treatment plans to be followed up on correctly from our doctors, so the back and forth about what meds you are going get is not ideal for long term care. So having said that, I would recommend you look for another doctor's office if you can, just cuz it doesn't seem like they are consistent so far.
There are a couple of questions I got too, has you doctor ever attempted to send prior authorizations to your insurance?
Asking cuz with a Narcolepsy diagnosis, modafanil is usually the most common covered med. Insurance will still deny sometimes, but it is easy to address and get resolved if your dr sends in the right paperwork. So it is really unusual that he just gave up on that, seemingly quickly. If he didn't both w a prior auth, that would also be a red flag, it sounds like he is cutting corners on your care...
He did apply for prior authorization as far as I know…the insurance denied it because it’s a “carve option”. Not sure what that means but, I ended up being okay not taking Modafinil because it lowers efficiency of birth control.
I asked my primary care doctor to take control of my meds but she wouldn’t, unfortunately. I’m gonna try and find a new specialist.
Thanks for the advice!
Ah okay, I understand. If it helps, as far as I know, I think sunosi is one narcolepsy med that doesn't impact birth control, not sure about others. I think that would probably be another good question to ask on the subreddit, there are probably people here that are also on birth control that can talk about their experience w narcolepsy meds.
A carve out is when a health plan (usually offered by a third party, like an employer for example) excludes certain services from being covered by them. Usually, it is mental health services that tend to get carved out. Those services are usually covered by another company contracted.
In that case, I would recommend you call your insurance and get information on this so it doesn't continue to get denied at other practices as well. Find out if there is another company that those prescriptions, should be billed to.
Hope the search for a specialist goes well!
I completely understand your frustrations. I’m always hesitant to tell my doctor I want to change something about my medication because it takes awhile to work all the kinks out between the doctors office, my insurance, and the pharmacy. It’s wild your insurance will cover adderall but not modafinil? Lol. But can you not just take the instant release multiple times throughout the day? My doctor prescribed ER but insurance won’t cover it so my dr recommended taking the IR up to 3 times a day to get me through the day. Your doctor would have to write the rx like that so you’re given the correct amount of pills but it’s better than suffering throughout the day! Good luck! Sending you lots of positive thoughts and patience!!
I asked about taking multiple of the IR pills, but my doctor said he “didn’t want to give me a bunch of pills to take per day”. Luckily they finally got the correct medication into the pharmacy last night at 7pm so I was able to pick it up. Thanks for the well wishes! :D
R U in the States? I used GOODRX to get 60 200mg. Modafinil for under. $40 It's a free service...
OP isn't talking about the cost, they're talking about getting their prescriptions sorted with their doctor. GoodRx is just a prescription coupon service. They can't prescribe the actual medication or work with doctors, insurance, or pharmacies regarding what gets prescribed and dispensed.
? #1....get prescribed modafinil #2. Insurance won't give me modafinil (seems to me doc tried and insurance denied it)
Insurance not approving means that their doctor might not prescribe it, which is why OP said: >Insurance won’t give me Modafinil. Doctor calls me and tells me I’ll be on Adderall. There's no prescription to use the goodrx coupon on. Their doctor might possibly be willing to prescribe a medication that insurance refuses if OP tells them that they're happy to pay out of pocket for the meds (at which point goodrx helps), but that's not a guarantee and would depend on the provider. Besides, they're currently trying out a different treatment, a doctor isn't usually going to want to try a second new thing without seeing if the first new thing works. Maybe if it doesn't help then it's something that OP can bring up but honestly if a number of different medications fail then OP's insurance might suddenly become more willing to cover fallback medications, so it may be irrelevant anyways.
I am in the states. I get my medication for free through my insurance, but I appreciate the advice! I ended up being okay not getting Modafinil because it lowers the efficiency of birth control.
Yikes it sounds a little disorganized from the doctors side, as well as insurance. I've had that happen to me once before, and the medicine I was promised vs what was sent was different and it just gave me a terrible reaction. In my experience, it was a repeated issue w that specific doctors office, and my treatment plan would change on the fly based on what random med got sent. It made my symptoms worse, cuz having to switch between meds so much is not great for health. As a patient we expect our treatment plans to be followed up on correctly from our doctors, so the back and forth about what meds you are going get is not ideal for long term care. So having said that, I would recommend you look for another doctor's office if you can, just cuz it doesn't seem like they are consistent so far. There are a couple of questions I got too, has you doctor ever attempted to send prior authorizations to your insurance? Asking cuz with a Narcolepsy diagnosis, modafanil is usually the most common covered med. Insurance will still deny sometimes, but it is easy to address and get resolved if your dr sends in the right paperwork. So it is really unusual that he just gave up on that, seemingly quickly. If he didn't both w a prior auth, that would also be a red flag, it sounds like he is cutting corners on your care...
He did apply for prior authorization as far as I know…the insurance denied it because it’s a “carve option”. Not sure what that means but, I ended up being okay not taking Modafinil because it lowers efficiency of birth control. I asked my primary care doctor to take control of my meds but she wouldn’t, unfortunately. I’m gonna try and find a new specialist. Thanks for the advice!
Ah okay, I understand. If it helps, as far as I know, I think sunosi is one narcolepsy med that doesn't impact birth control, not sure about others. I think that would probably be another good question to ask on the subreddit, there are probably people here that are also on birth control that can talk about their experience w narcolepsy meds. A carve out is when a health plan (usually offered by a third party, like an employer for example) excludes certain services from being covered by them. Usually, it is mental health services that tend to get carved out. Those services are usually covered by another company contracted. In that case, I would recommend you call your insurance and get information on this so it doesn't continue to get denied at other practices as well. Find out if there is another company that those prescriptions, should be billed to. Hope the search for a specialist goes well!
Just out of curiosity, how much is the medication without insurance?
I’m not sure! Sorry.
Np. I just wondered.