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Old 11-02-2019, 08:38 PM
Suebee Suebee is offline
MS Whisperer
 
Join Date: Mar 2015
Location: Houston, TX
Posts: 461
Default Update / continued question about modafinil coverage

My husband called today to verify that More than 30 modafinil pills a month are not covered under my bcbs anthem coverage. Initially the insurer rep incorrectly told us to file a renewed request For pre authorization with documentation from doctor but after pushing and waiting on hold awhile the customer rep conceded that I could only get a quantity of 30 pills a month... rep had no info about why... but did throw out there it was A controlled substance. I also got denial letter today citing quantity rule under “policy rule 1599” which is available upon request only. A search of the web only uncovered similar Tufts recent change in policy, limiting quantity of modafinil to 180 pills for 90 days. Similar to Anthem, It doesn’t list mg strength. Regardless tufts covers 2 modafinil pills a day vs. Anthem’s 1 a day. Anyone else getting changes to coverage??? This is exactly why drug trials need to be funded for MS. Use of modafinil “off label” puts MSers at risk of the whims of insurers. Anyone have a clue as to what is pushing this change?..

Here is tufts current policy on modafinil
https://tuftshealthplan.com/document...elines/nuvigil
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