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Pulmonology Coding Alert

Reader Questions:

Look to Third-Party Payers for Provigil

Published on Tue Sep 28, 2004

Question: Can our practice do anything to receive approval from insurance carriers to prescribe Provigil to patients with idiopathic hypersomnia? Now we need to have filed two written appeals before we can even gain a phone conversation, and the whole process takes about three months to get approved by carriers. 

Nebraska Subscriber Answer: Provigil, generic name modafinil, is a wake-promoting agent. This is an agent that physicians prescribe for the treatment of narcolepsy, obstructive sleep apnea and shift-work disorder. This medication is not yet approved for the treatment of idiopathic hypersomnia.

Unfortunately, until this drug is approved for the treatment of idiopathic hypersomnia, you cannot avoid an application for payment to the third-party payers.
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