Steve Hutchison (foomf) wrote,
Steve Hutchison

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Zombie Weekend

My health insurance is through UHC. They subcontract prescription coverage to MedCo, but the things they will pay for are strictly regulated on a formulary that does not allow for significant variation.

I have narcolepsy. This is a neurological disorder caused by an auto-immune thing; the cells in the brain that make the neurotransmitter 'hypocretin' aka 'orexin' are destroyed by the immune system, leaving behind too few of them to provide sufficient of the stuff to go through the whole day. Being asleep allows the brain to make more of the stuff, and to recover and recycle what it has.

Orexin is part of the adrenal hormone regulatory system, and anything else here is massively oversimplifying things. Basically the chemicals have a profound effect on alertness and on energy levels.

Last year, when I was getting adjusted to wearing a mouthpiece to reduce my nighttime breathing problems (my airway would close down to ALMOST closed, which it turns out was worse than complete closure in terms of oxygen deprivation) I found myself wanting to increase my dose of Provigil, and at the time, was told that switching to the newer product 'Nuvigil' by the same manufacturer (Cephalon) could increase the effective usefulness of the drug for me; 'armodafinil' (r-Modafinil) is a variant on the basic Modafinil (provigil) ... and Cephalon was busy trying to prevent Provigil from becoming a generic drug by bribing other companies not to make the stuff (after suing them to force them to stop preparations to sell a generic) and generally acting against the best interests of the people to who BUY the drugs.

UHC refused to pay for my increased dosage (given the price I don't blame them: $1200/105 tabs = $11.43 per tablet, which I would have had to pay on Thursday from my own pocket, and I was hoping to add 45 tabs, taking it to 150 tabs per 30 days.) My neurologist had some Nuvigil samples and I tried them. The effect was good, but the duration seemed off. It woke me faster, tapered off harder at 2pm when I normally need a 10 minute nap to replenish my neurotransmitters (and cannot take one when I'm working at Intel).

The result: I was refused outright by UHC when we tried to change to Nuvigil because it wasn't on the formulary. Now, it is, and they pulled Provigil OFF the formulary.

As of Thursday I had enough tablets for 3 days; one for Friday, skip the weekend, then enough for Monday and Tuesday if I needed them, because I might not be able to get things going from the pharmacy. Calls on Thursday and Friday to my neurologist (who is on vacation until the 19th of July) meant they were trying to get the drugs, and at a sufficient dosage. Now I'm not sure what the outcome will be for this. I don't know yet what dosage I will need to function optimally without being kept awake all night.

So yesterday I got the call that my variation had been approved, but there is not yet a prescription submitted at Costco. I was a total zombie yesterday, fell asleep twice, staggered around in a daze, still managed to get in a workout with my trainer. Today I took one of the tabs I intended to save for Tuesday because I _must_ be functional to get some work done. I'll probably take the other one after a nap. Still zombie-ing.

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