Modafinil (Provigil) Medicare Coverage

Modafinil
Chemical name: Modafinil

Brand name: Provigil

Typical dosage: 200mg

Typical type: Tablet1

Modafinil is a medication used to improve wakefulness due to a variety of sleeping disorders. Modafinil is available as a brand name or a generic and comes as an oral tablet.

Modafinil is a medication used to help improve wakefulness in adults with narcolepsy, obstructive sleep apnea and sleeping disorders due to working late shifts. The brand name equivalent of Modafinil is called Provigil.

Modafinil is typically taken once daily and is sometimes used only as needed, depending on what condition you are using it for.

Common side effects of Modafinil include feeling nervous or excited, headache, diarrhea, trouble sleeping, back pain, dizziness, upset stomach and runny or stuffy nose.

Does Medicare cover Modafinil or Provigil?

Yes! 71% of Medicare Advantage plans and Medicare Part D plans cover Modafinil.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Modafinil.

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Average costs for Modafinil with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$15 – $901 $11 – $392

Additional information

You do not have to take Modafinil with food, but you can if it upsets your stomach.

If you are taking Modafinil to treat a shift work sleep problem, take it 1 hour before the start of your shift. If you are taking Modafinil for narcolepsy or sleep apnea, take your dose in the morning.

Avoid drinking alcohol while taking Modafinil.

Modafinil can sometimes cause people to have mood changes or suicidal thoughts. If you experience either of these, talk to your doctor right away. Signs include depression, nervousness, anxiety or lack of interest in life.

Modafinil can also increase blood pressure. You may have increased blood pressure if you experience headaches, dizziness, changes in eyesight or if you pass out.

Heart problems can sometimes result from taking Modafinil. Talk to your doctor if you experience chest pain, abnormal heartbeat or unusual shortness of breath.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Modafinil. Retrieved Sep. 2019, from www.goodrx.com/modafinil.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.