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Who prescribes your stimulant med? And for what reason?


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So, I’ve been on nuvigil for 6 years. Pdoc had agreed to prescribe nuvigil for me (instead of my sleep dr, whom I don’t need to see any longer) but pdoc hit a roadblock with insurance. Insurance says no way are we covering nuvigil for you unless you have a diagnosed sleep disorder. #$*=#!!

I don’t have any diagnosed sleep disorders anymore. Unless I redo the daytime sleep study which would be inconclusive again because I can’t go off all my meds for weeks just to do a proper daytime sleep study to prove I have hypersomnia or narcolepsy. I don’t have sleep apnea anymore. Even my sleep dr thinks so. I barely qualified for having it 70 lbs ago. Sleep dr is a stickler for the rules though and wants me to do a daytime study again! I think she expects me to stop my meds this time! (NOT happening!)

Is my only option to taper off of nuvigil extremely slowly? I have about 3 months worth of 50 mg pills, and 2 months worth of 150 mg pills left in refills. I don’t think making changes to my cocktail is wise. But I see no other options. Insurance won’t cover it. I didn’t do that well on Ritalin or provigil. I got mood reactions like mania. It was a journey finding nuvigil and the right dose at that. Do I ask my pdoc about adderall? I don’t want to look like I’m drug seeking. 

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Don’t start tapering on your own.  Talk to your pdoc first.  
 

my insurance won’t cover nuvigil, so I take provigil. I have obstructive sleep apnea. My sleep dr prescribed it.  I would be upset if they took it away.

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Just now, confused said:

Don’t start tapering on your own.  Talk to your pdoc first.  
 

my insurance won’t cover nuvigil, so I take provigil. I have obstructive sleep apnea. My sleep dr prescribed it.  I would be upset if they took it away.

My pdoc doesn’t prescribe me nuvigil. She tried to. I talked to her nurse today and got a “sorry we tried to get nuvigil for you but insurance wouldn’t allow it unless you have a sleep disorder! You’ll have to find another dr to prescribe it! Thanks! Bye!”

My sleep dr won’t continue to prescribe my nuvigil unless I do another daytime sleep study. But I don’t have narcolepsy. I think I’d know. Nuvigil isn’t approved for any other things I think except sleep shift work disorder. And my insurance will only pay for nuvigil if I have a diagnosed disorder that nuvigil is approved for. 

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4 minutes ago, Wonderful.Cheese said:

My pdoc doesn’t prescribe me nuvigil. She tried to. I talked to her nurse today and got a “sorry we tried to get nuvigil for you but insurance wouldn’t allow it unless you have a sleep disorder! You’ll have to find another dr to prescribe it! Thanks! Bye!”

My sleep dr won’t continue to prescribe my nuvigil unless I do another daytime sleep study. But I don’t have narcolepsy. I think I’d know. Nuvigil isn’t approved for any other things I think except sleep shift work disorder. And my insurance will only pay for nuvigil if I have a diagnosed disorder that nuvigil is approved for. 

Wow. That nurse was not very helpful

What is your sleep issue? If you have to taper get advice from who prescribed it 

I don't have narcolepsy, either I have apnea and have tiredness in the daytime even with treatment. I did not go off meds for my sleep study. I did one there and have done 2 at home. 

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1 hour ago, Wonderful.Cheese said:

So, I’ve been on nuvigil for 6 years. Pdoc had agreed to prescribe nuvigil for me (instead of my sleep dr, whom I don’t need to see any longer) but pdoc hit a roadblock with insurance. Insurance says no way are we covering nuvigil for you unless you have a diagnosed sleep disorder. #$*=#!!

I don’t have any diagnosed sleep disorders anymore. Unless I redo the daytime sleep study which would be inconclusive again because I can’t go off all my meds for weeks just to do a proper daytime sleep study to prove I have hypersomnia or narcolepsy. I don’t have sleep apnea anymore. Even my sleep dr thinks so. I barely qualified for having it 70 lbs ago. Sleep dr is a stickler for the rules though and wants me to do a daytime study again! I think she expects me to stop my meds this time! (NOT happening!)

Is my only option to taper off of nuvigil extremely slowly? I have about 3 months worth of 50 mg pills, and 2 months worth of 150 mg pills left in refills. I don’t think making changes to my cocktail is wise. But I see no other options. Insurance won’t cover it. I didn’t do that well on Ritalin or provigil. I got mood reactions like mania. It was a journey finding nuvigil and the right dose at that. Do I ask my pdoc about adderall? I don’t want to look like I’m drug seeking. 

If you give that whole story to your pdoc and present your dilemma and get the insurance to verify, I don’t think that would be considered drug seeking as long as your open minded and come off as looking for all solutions and not just going for a specific med 

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2 hours ago, confused said:

Wow. That nurse was not very helpful

What is your sleep issue? If you have to taper get advice from who prescribed it 

I don't have narcolepsy, either I have apnea and have tiredness in the daytime even with treatment. I did not go off meds for my sleep study. I did one there and have done 2 at home. 

Thanks confused. I know. My pdoc’s nurse isn’t very helpful all the time! Eeeek.

I was taking the nuvigil when I had sleep apnea and was using my CPAP. I stopped using CPAP in January and had an appointment with my sleep dr who thought I could taper off the nuvigil and since my weight loss she believed I no longer had sleep apnea since I barely qualified for it 70 lbs ago.

So I failed the taper plan rather quickly because I was super tired all day and the nurse for sleep dr said to restart my nuvigil and they’d have me do another daytime sleep study then PANDEMIC then they just gave me a few months refills of the nuvigil doses I take and here we are now.

Their sleep clinic is closed. I can try calling again tomorrow because it’s been a while. Just to ask about the taper. 

But I don’t have narcolepsy and I don’t have sleep apnea and I don’t have sleep shift work disorder so my insurance won’t pay for nuvigil. It already needs a prior authorization for the approved uses. They won’t pay for anything off label. I’m stuck. 

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1 hour ago, Iceberg said:

If you give that whole story to your pdoc and present your dilemma and get the insurance to verify, I don’t think that would be considered drug seeking as long as your open minded and come off as looking for all solutions and not just going for a specific med 

Thanks iceberg. I don’t see my pdoc until end of May. I remember pdoc wouldn’t prescribe me vyvanase for binge eating as was wanted by my weight management dr. So I’m worried pdoc won’t prescribe me any kind of stimulant med because MANIA. So. But do I call her nurse again and ask if pdoc will prescribe any kind of stimulant for me? In place of the nuvigil? I was thinking adderal XR because I have never tried it. Would insurance approve that or no? 

59 minutes ago, Banana Smurf said:

I am prescribed ritalin by a sleep dr.  I couldn't go off my medications for my daytime sleep study, either.  I think it's kind of weird they're insisting on a clean sleep study after that long.  

My sleep dr is very strict and very much a go by the book rule follower. I really like her but she can be extreme like that. I’m at a loss. 

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Cheese I am so sorry you are having to deal with this.  I would try calling the sleep clinic.  They may be able to help you over the phone.

Congrats on improving the sleep apnea. My husband would never go for a test but I thought he had sleep apnea. He has lost weight and doesn't even snore anymore.

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36 minutes ago, Wonderful.Cheese said:

Thanks iceberg. I don’t see my pdoc until end of May. I remember pdoc wouldn’t prescribe me vyvanase for binge eating as was wanted by my weight management dr. So I’m worried pdoc won’t prescribe me any kind of stimulant med because MANIA. So. But do I call her nurse again and ask if pdoc will prescribe any kind of stimulant for me? In place of the nuvigil? I was thinking adderal XR because I have never tried it. Would insurance approve that or no? 

My sleep dr is very strict and very much a go by the book rule follower. I really like her but she can be extreme like that. I’m at a loss. 

maybe instead of asking for a stimulant specifically, you could say that you have been taken off the med, which was helping you, and want to know if your pdoc has any ideas about how to handle the change 

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12 hours ago, confused said:

Cheese I am so sorry you are having to deal with this.  I would try calling the sleep clinic.  They may be able to help you over the phone.

Congrats on improving the sleep apnea. My husband would never go for a test but I thought he had sleep apnea. He has lost weight and doesn't even snore anymore.

Thank you confused. I will update. 

12 hours ago, Iceberg said:

maybe instead of asking for a stimulant specifically, you could say that you have been taken off the med, which was helping you, and want to know if your pdoc has any ideas about how to handle the change 

This will be my backup plan thanks iceberg!

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My pdoc prescribes all of my stimulants. First, it was Provigil. Was on it a few months, got up to 400mg pretty quickly, decided it wasn't doing anything, and tapered off. Tried it again some time later, but same result unfortunately, just took less time to realize that. Now, I'm on 30mg of Adderall BID. Don't really notice much of a difference other than maybe consuming a little less coffee during the day. Have even gone up to 60mg at one time(pdoc knows about it and trusts me), just out of curiosity, but didn't see all that much of a difference. Definitely not the way people describe it working for them, ADHD diagnosis or not, but maybe that's only when people take way too high of a dose or mess with the route of administration by crushing and snorting them. And even if it did have that kind of positive effect, you'd never be able to convince me to take that risk as, working on a psychotic disorders inpatient unit, I've seen and worked with some people who got really messed up abusing stimulants. 

My sleep doc was just for the initial sleep apnea diagnosis, cpap machine set up, and three month follow ups. I've never asked her if she'd prescribe a stimulant. I'm not sure what she'd say. My guess would be no, if only because she's expressed before her dislike of me taking any sort of sleep medications (especially benzos and z drugs), which I understand, because they affect your upper airway and can cause respiratory depression, which will obviously make sleep apnea worse. 

I never had an issue with my insurance paying for either Provigil or Adderall. I'm not sure if my pdoc wrote the reason for prescribing them or if he had to for insurance purposes, but they were both ultimately off-label for depression (anhedonia). But as I said before, I do have a history of testing for, and diagnosis of, sleep apnea, so maybe they saw that and just assumed. Not sure. 

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On 5/1/2020 at 10:44 PM, psychwardjesus said:

My pdoc prescribes all of my stimulants. First, it was Provigil. Was on it a few months, got up to 400mg pretty quickly, decided it wasn't doing anything, and tapered off. Tried it again some time later, but same result unfortunately, just took less time to realize that. Now, I'm on 30mg of Adderall BID. Don't really notice much of a difference other than maybe consuming a little less coffee during the day. Have even gone up to 60mg at one time(pdoc knows about it and trusts me), just out of curiosity, but didn't see all that much of a difference. Definitely not the way people describe it working for them, ADHD diagnosis or not, but maybe that's only when people take way too high of a dose or mess with the route of administration by crushing and snorting them. And even if it did have that kind of positive effect, you'd never be able to convince me to take that risk as, working on a psychotic disorders inpatient unit, I've seen and worked with some people who got really messed up abusing stimulants. 

My sleep doc was just for the initial sleep apnea diagnosis, cpap machine set up, and three month follow ups. I've never asked her if she'd prescribe a stimulant. I'm not sure what she'd say. My guess would be no, if only because she's expressed before her dislike of me taking any sort of sleep medications (especially benzos and z drugs), which I understand, because they affect your upper airway and can cause respiratory depression, which will obviously make sleep apnea worse. 

I never had an issue with my insurance paying for either Provigil or Adderall. I'm not sure if my pdoc wrote the reason for prescribing them or if he had to for insurance purposes, but they were both ultimately off-label for depression (anhedonia). But as I said before, I do have a history of testing for, and diagnosis of, sleep apnea, so maybe they saw that and just assumed. Not sure. 

Thanks. I don’t know what reason my pdoc wrote for prescribing me the nuvigil. I have a history of having sleep apnea. But no more. I wonder what my pdoc wrote. I know it can be used off label as help with depression. I know it helps my mood. It’s the one stimulant type med that hasn’t messed with causing me mania or worsened my psychosis. And if I can’t get it prescribed, I’ll go back to sleeping 18 hours a day again. No fun. I’m at a loss. It’s really an essential part of my med cocktail. 

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So I have resumed taking the nuvigil for now. Just at 150 mg instead of my 200 mg dose.

I received a denial letter from my insurance stating that tiredness from meds was not an approved use for nuvigil and therefore they wouldn’t pay for it but that my dr can appeal. But I haven’t heard back from pdoc’s nurse if my pdoc is even willing to appeal. And I wonder how long an appeal will take too.

So I called pdoc’s nurse again today and told her that nuvigil helps my mood too in addition to the tiredness and asked if she had heard from pdoc yet or not regarding if pdoc will appeal for me or not. Asking what I’m supposed to do? If I should stop it even though I don’t think I should? Call sleep dr?

I don’t know what to do. Sleep dr will want more sleep studies even though I’ve had 3! And she will want me off some to all of my meds for the daytime sleep study to get accurate results this time around. What is the point even? I’m not going off meds and if I repeat the day study with meds the results won’t change! I don’t have narcolepsy or sleep apnea and those are the only ways my insurance pays for nuvigil. (Besides sleep shift work, and I don’t work)

I’m pulling out my hair here. 

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On 5/5/2020 at 1:30 PM, Iceberg said:

@Wonderful.Cheese - i might file calling the sleep Dr under “can’t hurt” ... worst she can say is no, but maybe she’ll have a change of heart hearing about how tough the situation is and how you can’t afford to stop meds 

Thanks iceberg. You are a wealth of good advice and knowledge. I still haven't heard back from my pdoc's nurse. No surprise there. UGH. I guess I will have to call sleep dr today. I see tdoc in about 15 ish minutes. I will run this by her. She doesn't work at the county clinic (stupid budget cuts forcing me to find therapy elsewhere $$$$$), so she can't just email pdoc or her nurse. ARGH

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