Modafinil (Provigil) Medicare Coverage

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.

How much does Modafinil cost with Medicare?

Modafinil coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Modafinil?

According to GoodRx, 87% of Medicare Advantage plans and Medicare Part D plans covered Modafinil in 2023.¹

• Medicare Advantage plans or Part D plans that cover Modafinil include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.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. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

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.