Process to obtaining prescription for modafinil

22 posts in this topic

Posted

I am an American living in Germany. I am privately insured. I have daytime fatigue. I don't have narcolepsy, just fatigue. The fatigue makes it quite difficult to stay on task, be organized and learn German.

Has anybody here been prescribed modafinil (Vigil) in Germany?

Could anybody tell me what kind of a process to expect if I was to seek medical advice for daytime fatigue?

Also, does anybody know the cost of modafinil and if my insurance might cover it.

Answers or suggestions to the above questions would be greatly appreciated. Thanks!

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Posted

did you already talk to your health insurance people? can a native German speaker help you to make the call.

they will know 100% what they cover.

I think it is advisable to go to your doctor and explain about your fatigue and enquire about the medication you mention.

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Posted

You would need to see a doctor who would review your medical history. Do you have any documents detailing a previous diagnosis? Apparently modafinil was made a prescription medication in Germany in 2008.

From the Wikipedia article it looks like some health insurances will pay for it if it's prescribed for narcolepsy. Other uses are off-label and the patient would have to pay out of pocket.

Here's an example of what it might cost.

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Posted

If a doctor prescribes medicine for your condition then the payment would normally be covered by your insurance, but it depends of course on the conditions of insurance, and especially any deductibles you have agreed to. Only a medical professional can prescribe the medicine, and they are not likely to do it "on demand". They will want to analyse your condition, make their own diagnosis and prescribe the medication (if any) they think most suitable. If you have previously been treated using the same medicine this may influence their prescription decision, but as medicine is not an exact science and it is rare that two doctors ever agree, don't bank on it.

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Posted

This is my first time replying so I am not sure if I did it correctly. I looked for a reply button to each comment but didn't see one.

@Moonboot, I have not spoken with my insurance company yet. I was thinking of going to the doctor first to see how they would handle my fatigue. Forgot to mention (because I actually forgot i did this) that last year I went to the doctor for fatigue and they had me wear a strap that monitored my blood pressure for 24 hours. My bp was fine and that was that. They didn't know how else to help me. Maybe I saw the wrong type of doctor. It was a Hausarzt.

@westvan, My Hausartz does have my medical history. I haven't been diagnosed with anything from them or from the States as far as fatigue is concerned.

Thanks for the replies.

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Posted

Yep, just make an appointment with your doctor and tell him that the fatigue hasn't let up. He'll be the one to decide which medication (if any) to prescribe.

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Posted

I can't speak to the medical likelihood of scholarmel getting a prescription in this case. However, I can confirm that public insurance at least will pay for "on-label" use with no questions asked. (The diagnostic process generally involves a neurologist and a sleep study, among other things, and is not quick. Incidentally, most GPs won't prescribe the medication themselves, because it's too expensive. With a diagnosis, though, there's no trouble with specialists.)

To be honest, I would be very surprised (and irritated, but that's hardly scholarmel's fault) to see a Hausarzt prescribe Modafinil without further investigation, particularly for "off-label" use, but maybe private insurance really is that different.

(There's a certain irony in having access to medication that lots of people seem to want when you would give a great deal not to need it, but I suppose that's life.)

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Posted

Flavia, I don't think a Hausartz would write a prescription for this either. I wouldn't have much faith in them if the just prescribed me meds. I would rather rule everything out. I'd rather treat the real problem as opposed to masking my fatigue.

Thanks for your thoughts :-)

One problem with ruling everything out is that they may go overboard with my fancy dancy private insurance. Their eyes perk up when they realize it isn't the social health insurance...

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Posted

In my experience, docs here are very unlikely to prescribe such medicine. I have a diagnosed disease that would be covered for Provigil, but my doctor won't budge as of yet.

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Posted

westvan sums it up quite well.

Regarding the process for daytime fatigue treatment it may look something like:

Go to GP and get a checkup, get sent to a specialist in sleep medicine (ask to be sent?), go through various sleep tests, maybe have a neurological test, and who know what else these days, but everyone's different as are the docs, so ymmv.

Did they do a blood test when you went first time? Tests for anemia, deficiencies, thyroid problems those sorts of things may be worth talking about with your doc.

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Posted

All those things should have been tested the first time. If they just monitored blood pressure it might be time for a new GP.

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Posted

If you are used to the US system, you find that it's almost impossible to be prescribed (here) Modafinil or Ritalin or something similar. (I am always shocked by the amount of meds my US friends can easily get)

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Posted

Yes, I believe Ritalin and other ADD/ADHD medications are only prescribed for children here. If adults can get them at all they pay out of pocket.

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Posted

I think it's not just that, they will likely not be prescribed at all...unless the condition is really extreme.

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Posted

I think it's being prescribed more and more in Germany these days and was actually approved for adult use in 2011. I wasn't aware of that. Anwendungsgebiete

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Posted

Why are you trying to get drugs rather than cure your problem? Have you been tested for sleep apnea or anything else that would just make you tired? (How about going to bed earlier? less exhausting sex?)

German docs will generally be very suspicious if you just rock up and say "gimme some speed, man" - theyll alway want to have a diagnosis to hang anything on and as a general rule, mood-changing pharmaceuticals are a lot less common here than there.

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Posted

Not a chance you will be prescribed these without an extensive work-up to rule out the more common forms of fatigue as mentioned by Neilg.

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Posted

Even if it is not the desired reply try everything to stay clear of this stuff. It is addictive and you may lead you to take even stronger drugs.

Have you taken counsel by sleep therapist?

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Posted

Before you go see a sleep specialist, if your Hausarzt has really only checked your blood pressure (in that case: what an idiot), why not try another one and ask him/her to test your blood for a lack of iron and/or hypothyroidism, two very common causes of fatigue.

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Posted

Don't the Doctors in the USA get money from the Drug Companies for writing a lot of prescriptions from that company?

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Posted

Modafinil is considered a psychostimulance unsuitable to be prescribed for any sickness other than narcolepsy throughout the European Union (official recommendation by the European Drug Agency 2011). It is explicitly not recommended - unlike in the USA - for patients with other sicknesses such as MS, depression or ADHS.

It was considered a drug in the legal/illegal sense in Germany until 2008, and its abuse and abuse potential is relatively widely known. Hence why doctors will not prescribe it to you.

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Posted (edited)

I think you can also get modafinil for chronic daytime sleepiness, but that diagnosis is pretty hard to pin down too.

One problem with ruling everything out is that they may go overboard with my fancy dancy private insurance. Their eyes perk up when they realize it isn't the social health insurance...

I only have public insurance, but this sort of thing tends to take fairly extensive testing to diagnose anyway. At a minimum, once you're in the hands of a sleep specialist you'll need an overnight - or longer - clinic or hospital stay for a sleep study, plus various other tests. (I think you need a pre-prescription EEG for comparison anyway.) With a diagnosis and medication, there are then quarterly EEGs, EKGs, and blood tests. Even with private insurance, I imagine there's only so much they can do!

---

Have edited out most of my original response because on reflection it was more info than I was comfortable giving. Anything more I can say via PM, if there's interest. Otherwise, scholarmel, good luck sorting out your health problems. Sleep disorders aren't fun (nothing like falling asleep randomly or collapsing in a heap to brighten up one's day), but they are manageable, and you don't have to end up as a character from Trainspotting ;)

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