Does Medicare Cover Modafinil?

Modafinil is a medication used to treat narcolepsy and other sleep disorders. It was first developed in the 1970s, but it wasn't approved for use in the United States until 1998.

Since gaining FDA approval, modafinil has steadily risen in popularity and is now considered a frontline treatment for a variety of sleep ailments. Modafinil works by stimulating the central nervous system, helping you focus and stay awake.

When Does Medicare Pay for Modafinil?

Medicare Advantage (Part C) plans with prescription drug coverage and Medicare Part D prescription drug plans may cover modafinil, but not all of them do. Since not all plans in either of these categories cover modafinil, you should ask your insurance agent specifically about how a Medicare plan covers modafinil before agreeing to purchase a policy.

According to GoodRx, 87% of Medicare drug plans cover modafinil.

How Much Does Modafinil Cost With Medicare?

The cost of modafinil with a Medicare drug plan varies, depending on the kind of coverage you have and whether you opt for the brand name (Provigil) or the generic version (modafinil). If you opt for the brand name and your Medicare plan doesn't cover it, you could be looking at a cost as high as $900 to $1,000 per month.

On the other hand, if you take the generic version and it's covered by your Medicare Part D or Medicare Advantage plan, you will likely pay lower copays, coinsurance and/or deductible amounts than you would for the name brand version.

What is Modafinil Used For?

Modafinil is a wake-promoting agent. It treats conditions, such as narcolepsy, obstructive sleep apnea and shift work sleep disorder. It can also be used to treat excessive daytime sleepiness resulting from other causes. The medication works by increasing dopamine levels in the brain.

When taken in responsible doses under the close supervision of a doctor, modafinil has been shown to be safe and well-tolerated. It can be used either as a frontline therapy or as an adjunct therapy when other medications fail.

How Do I Take Modafinil?

Modafinil is usually taken once per day by mouth, either with or without food. You can only get modafinil with a prescription, and you should take it exactly as your doctor tells you to. If you're taking modafinil for shift work sleep disorder, for example, your doctor might have you take your dose 30 to 60 minutes before the start of your work shift each day, rather than first thing in the morning. If you work a rotating or varying shift, your doctor can help you plan out a safe and effective dosing schedule.

When taking modafinil, never take more than prescribed or deviate from your doctor's instructions. If these instructions are unclear, you should schedule a follow-up appointment with your doctor or have your pharmacist explain your prescription to you before taking your first dose.

It's important to be aware that just because modafinil can decrease sleepiness doesn't make it a suitable replacement for sleep. You still need adequate sleep each night for good health. For most adults, this means somewhere between 7 and 9 hours. If modafinil causes insomnia or prevents you from getting a full night's sleep, you might need to see your doctor about a dose adjustment. A sleep study can help you gauge the quality of your sleep each night. 

Modafinil Side Effects

Like most prescription drugs, modafinil can cause side effects. Sometimes they're dose dependent; when a patient's dose is too high, they experience adverse reactions. But when they lower their dose, the side effects go away.

Although side effects from modafinil are mostly rare and tend to be mild when they do occur, serious adverse reactions are possible. If you notice any major changes in your body after starting modafinil, you should call your doctor right away. Here are a few things to watch out for:

• Nausea
• Headache
• Dizziness
• Increased appetite
• Chest pain
• Chills or fever
• Black, tarry stools

Are There Other Medications That Do the Same Thing as Modafinil?

Modafinil is not effective in some patients, and in others, it causes intolerable side effects. These patients, with the help of their doctors, often seek out alternatives to modafinil. The most common alternative is armodafinil, which was created as a more potent alternative to modafinil and approved by the FDA in 2007.

Like modafinil, armodafinil is a central nervous system stimulant that has been shown to increase wakefulness and alertness, as well as cognitive function. It's also covered by most Medicare prescription drug plans.

Is Modafinil a Generic Medication?

Yes. Modafinil is the generic name for the brand name drug Provigil. Because it comes in generic form, it's affordable for most patients, regardless of the type of insurance coverage they have. Even patients without insurance can often find it for under $20 per month using prescription drug discount apps, such as GoodRx.