Modafinil or Amantadine: Who Decides?

Laura Kolaczkowski avatar

by Laura Kolaczkowski |

Share this article:

Share article via email
modafinil, medication costs

Fatigue. That No. 1 symptom that a large majority of people with multiple sclerosis are affected by.

MS fatigue. It can be crushing, numbing, and stop the hardiest person in their tracks. I know MS fatigue all too well because it affects me all the time.

Combating MS fatigue

What causes MS fatigue isn’t exactly known, but there are lots of educated guesses. It might be because it is a challenge to do anything physical and remain upright, thanks to balance problems. Or with MS, it is just exhausting to move because it takes extra effort for our central nervous system to get the right message. It could be a side effect of the medicines we take for other symptoms. It very well could be tied to depression, another common problem for people with MS. The list of possible causes of MS fatigue is lengthy.

Whatever the cause, we’re fortunate if we find something that helps us with fatigue. That help can come in the form of pharmaceuticals, although no FDA-approved therapy for MS fatigue exists. Everything we take for MS fatigue is done off-label, meaning it hasn’t been thoroughly studied for use in rigorous scientific trials.

I’ve been fortunate to have been prescribed modafinil (also known by the brand name Provigil) for over four years. While it isn’t perfect, it does keep me going through the day and it is obvious when I skip a dose. My energy reserve is depleted within a few hours of getting out of bed if I don’t take this medication. Modafinil is not an amphetamine, but it is a therapy approved for people who do shift-work through the night and need help with sleep disorders. It doesn’t work for everyone, but it does work for me.

I’ve also been fortunate to have this therapy available because people are often refused access as it isn’t an official multiple sclerosis medication.

Prescription changes

You can imagine my surprise and dismay when I received a call from my neurologist’s nurse today to let me know that my prescription refill for modafinil had been denied. I have a new pharmaceutical provider and am no longer in the Express Scripts system. Instead, I have Caremark, a division of CVS drugs. The CVS Caremark folks, whoever it is that makes the decisions, want me to try amantadine in place of modafinil. I wasn’t even familiar with this medication and am surprised to see it is an antiviral medicine used to treat influenza A symptoms and off-label for Parkinson’s disease and movement disorders.

Of course, this has me confused — I don’t see the connection with this recommended treatment and my MS fatigue. I find online notes that it is used off-label, but it has a low efficacy rate in helping with MS fatigue.

I was so caught off-guard by the phone call from the MS nurse, that I told her no, I don’t want to make the change and that she should appeal the insurance decision. I have success with modafinil and it makes no sense that I should change up therapies. As we have all been told over and over, if it ain’t broke, don’t fix it. Modafinil works for me, so why would I change?

Comparing costs

I can only hypothesize that the bottom line for their decision is money. A three-month supply of modafinil had been billed to my previous drug provider at about $4,500 (I take two a day over 90 days, or 180 tablets). Of course, the insurance company doesn’t pay this much, but this is the list price for a generic drug.

According to GoodRx, a website that specializes in helping people find the best pricing on prescriptions, the average cost of amantadine at the time of this writing is $120 for 180 capsules at Costco, a warehouse shopping club. The average price at Costco for 180 modafinil tablets is $175.

I have no idea why modafinil costs more, but should that be the factor that determines denial of a therapy that works? If Costco can sell me my 90-day prescription directly for $175, why did Express Scripts show that same cost at $4,500? It’s an easy leap to guess my new pharmacy insurance wants me to change treatments to save them money, even though it’s a therapy that works for me.

It’s broke — fix it

The prices shouldn’t be this far-ranging. Instead of the insurance provider, my doctor and I should decide what treatments I take. I’m now forced to wait and see the results of engaging Caremark in this appeal and hope I am not forced to stop taking this drug that makes a huge difference for my fatigue. Our system for prescription drugs, the ease of access to them, and who decides which ones we are allowed to take is broken. Isn’t it time for it to be fixed?


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.


Jo Jo avatar

Jo Jo

You are correct, it is very hard to get a drug that is not FDA-approved for MS. Modafinil didn't work for me. You should talk to your doctor about Naltrexone. I have been on this drug for approximately 5 weeks. After a week and a half I noticed Improvement in my fatigue, although it only lasts for a little better than a half a day but that half a day is better than nothing at all.
I am still waiting to see if my insurance company will cover it but the drug only cost me $47.00 for 30 pills. I have SPMS and this is the first drug that is help me with fatigue. I realized that all drugs affect everybody differently. But you should ask your doctor what he thinks about this drug.

Richard T Forsley avatar

Richard T Forsley

Having grown up with my mother having MS raised five children while caring for 32 mentally disturbed veterans who was always happy and walked with a cane until the age of 84 never taking any drugs but was powered by iced dark coffee I've done the same going on 33 years with MS! Also a cold shower reduces inflammation and will make you feel like a new person!

Joe avatar


Consider yourself very lucky that you and your mother had great genetics and were two cases of people who were not trounced by the disease, and barely afflicted by it. If you understood MS you wouldn’t be making comments as to how iced coffee and cold showers were all you needed. Honestly, I’m very happy you have no symptoms of MS, but you shouldn’t be offering up comments to people who are severely afflicted with the disease. Cheers ☕️ ☕️

Terry avatar


He did not say they had no symptoms. I am the same way. Got Multiple Sclerosis after a vaccine at 23, have a colostomy and use a catheter, plus have an subset of other ms issues, took Multiple Sclerosis drugs for two years and was sicker than sick, stopped taking Multiple Sclerosis drugs, dress every day as if I am going to work, put a smile on my face, and when people find out I have the disease they are shocked. My goal every day is to make someone else’s day better and never bring them down because of my own.

I used to take ONE EIGHTH of a Provigil pill every day to get through work. Any more wired me to the gills.

Andrea Wellman avatar

Andrea Wellman

No, that's ignorant victim blaming disgusted as as encouragement and we all know it. Dont pretend it is anything else...

A friend of mine ate mac and cheese each day and beat cancer... so...? Not sure what everyone is whining about...

And if you have depression, just smile.

Please, contact me directly. I wont be back, but look me up. I'd love to hear your vitriol. This garbage is what reminds me to keep fighting.

Sarah avatar


Hi Laura,
I'm in the UK, I had to fight for months to be prescribed Amandatine, which is the only drug that can be prescribed for MS fatigue! I finally got it and the first 3 days my head was a mess, I couldn't focus on just one thing at a time but I stuck with it. Then I had the best week I'd had in years! Cognition was better and I got things done that I wanted to do. 11 days in I had a heavy head, what felt like pressure and got a painless migraine with aura, the day after I had 2 in one day and I knew it was the amandatine, I was gutted! I had to stop taking it and the migraines stopped but the fatigue came back with a vengeance. So that's it, Iv just got to live with the fatigue, I hope you get to continue on the drug that suits you.

Elise avatar


There are other drugs that help fatigue. If your MS specialist doesn't know then visit a sleep doctor with experience with MS patients. That's how I found help.

I've also found even more help with fatigue using the Wahls Protocol diet (massively increasing the good fats in my diet, eating nutrient-dense foods and eliminating grains-sugar-dairy).

Best to you.

Helen avatar


Hi Sarah just read your comment, i know this is an old thread but I hope you are getting on ok. Im in Derbyshire and really struggling to get the prescription.

John Connor avatar

John Connor

It turns out Amantadine is good for walking. However when I came off Gilenya it gave me the side effect of severe diarrhea!!! Went onto Modafinil which gave me no side effects & I found was a better drug for clarity. Never found either good for dealing with fatigue but both combatted fuzziness or 'brain fog'. In the UK am covered by the NHS & ultimately NICE who decide on drug coverage.

Mark avatar


After many years of many scripts for MS, and fortunate enough to pick my insurance plan from an insurance broker's very large list of available policies, no cost to me because that was a company fully paid for benefit, and since I was the one choosing for everyone in the company which plan we all had, the Co-Pays for the ABC &Rebif drugs were $25! But those days are gone, and I watched medical insurance costs skyrocketing since I "retired" getting closer to a decade now. If one such as I did years ago, pick a plan not held back by cost, could one still get such a plan? And, what do our elected officials get?

Catherine avatar


Great the way some pharmaceutical company and your insurance can just decide to put you on a drug you have never taken before without even seeing you!!
I'm lucky in Ireland that I get Provigil every month on my prescription.

Bobbi Essagof avatar

Bobbi Essagof

I am having this fight right now. I just paid GoodRx at Stop & Shop $112+ fro 90 days of armodafanil. It was covered by Caremark but Medicare refuses to do it. I've been on it for 15 years and refuse to stop fighting. I'm new to medicare but I dread to see what else they won't cover.
As for all of you who say take a cold shower and get on with it, it must be nice to be so perfect. Why are you even reading this. Get out and run a few miles.
A little compassion for others goes a long way.
Thanks for your article. Very helpful

Debbie avatar


The same thing has happened to me. I had to request that the benefits administrator at work see what they could do and they agreed to authorize it indefinitely.

Margo Casey avatar

Margo Casey

Amadadine is not as effective with fatigue- in my case I had to try it first before I got approved for provigil. Stay with your appeal!


Eli avatar


17 years ago I was prescribed Amantadine for fatigue. It had no beneficial effect. Then I was switched to Provigil which had a dramatic dramatic beneficial effect. I have been on it, or modafinil, ever since. The choice should be up to us and our doctors.

Jacklynn avatar


I’ve been on Amantadine for 4 years. It has helped with fatigue. Had to adjust the dosage but doing ok. I have PPMS. Still working and walking ok. Try it. Don’t give in or give up

Lakisha avatar


How long did it take you to start feeling the benefits of using this drug

Gena R. Wright avatar

Gena R. Wright

I know how you feel. I'm on Gilenya. I was diagnosed with MS in December of 2017. My insurance wants me to try out the other injection medicines before I go further with the pill Gilenya. It's been working fine for me these past 2 months. I've been learning a lot about insurance companies and I see they like you to take stuff that is on their tier list of medicines first. I'm floored how a insurance company can dictate on what medicine you should take because of the deal they got with the pharmaceutical company.

Peter avatar


I’ve been on Amantadine for about 16 years, I take 100 mg twice a day - one pill in the morning and the second one 6 hours later.
It helps me a lot, giving me extra energy and stamina during the day. Amantadine worked for me when I was RRMS patient, and also now at SPMS.

Beth avatar


I had the same issue when my prescription coverage was switched to CVS/Caremark. They are truly the worst. They are intrusive and overly heavy handed. I have to fight with them constantly. I started getting Modafinil for $35 for 30 days at Costco just paying cash out of pocket. Then I learned that the pills from that manufacturer didn't actually work the same as my original script that I used to get from my local pharmacy. CVS/Caremark also forced me to mail order for my drugs when I was really happy with my local mom & pop drug store. I went back to them to talk about the difference between their pills and the Costco pills and they were indeed a different manufacturer. The Costco pills were from a manufacturer in India - nothing wrong with that but they didn't work for me at all. Like taking candy pills. I was able to negotiate the price for the original pills with my local pharmacy so I now pay $104/30 pills. I try not to take them every day because too many days in a row can mess me up (I get paranoid and oddly easily irritable). I hope you and your doctor are successful with your appeal. That company truly is the worst.



been on amantadine for 15 years with no side effects. I like the fact that it seems to protect from flu

Stefanie avatar


I feel your frustration! After having to go through the whole prior authorization run around with insurance I was finally able to get on Provigil/Modafinil. It helped and I refilled my Rx...unfortunately after a while I put two and two together and realized that the increase in headaches and upset stomach I was experiencing were related (I thought another Rx I had started on was the cause). Also unfortunate was that I had already refilled the Rx a third time before figuring out I couldn't take it anymore and the price had gone up for me too! I have a full, unopened bottle I would offer you in a heartbeat if I could! Now trying to get my doctor to prescribe Amantadine to try it out, he said it's unlikely to cause the same side effects, but still a bit nervous to try. Some days are ok, some I'm beyond exhausted, not sure what to do.

Wendy avatar


I have been an MS patients for over ten years now. When serious issues with fatigue resulted in excessive weight gain and almost cost me my career, I turned to Provigil. At the time it was rumored to benefit MS fatigue but not allowed to be prescribed for it. It was wonderful for 2 years! I was able to be active again and lose that excess weight. I could keep up with the employees half my age, enjoy active time with my grand daughter, and for the first time in a long time didn't feel like MS was stealing my life. Unfortunately Provigil became the designer drug of choice for Silicon Valley workaholics, and the drug became more restrictive in insurance approvals. When I was finally able to get prescription for it after fight the insurance company, a 30 day supply went from $30 to $1300 after co pay. I simply could not afford that. After several years of trying to manage without any thing for fatigue, I again got so inactive my weight gain was out of control, I experienced regular chest pains, and I had no energy to even get out of bed for work most days. Now that Provigil's patent has expired, I am finally able to get the generic Modafinil at an affordable price. I am looking forward to having my life back !!

James J. Faul avatar

James J. Faul

I have Narcolepsy and I am currently taking 200mg twice daily and it barely works. My doctor added Ritalin 20mg twice daily and I have been on Ritalin for previous years until I moved to TX. In 2013, I was prescribed Vyvanse 70mg I believe. It didn't work better than the Ritalin or Adderall I tried while in TX. My doctor then prescribed Xyrem. Needless to say, none of these drugs have provided adequate relief from daytime sleepiness. I started Provigil in January 2016 and there's no change. I took Provigil about 10 years ago and the same results. I need serious help because I barely function.

Debi avatar


I feel you. I have MS and Narcolepsy. I take dextroamphetamine amantadine and provigil. I still have no energy and still sleep when I don't want to. I tried Xyrem, but it raised my blood pressure and had to be taken off. It never went back down... I had always had low BP now I have another pill to take for that. I was on it for about 3 weeks and it was really beginning to work. It may be something you may want to look into. There is only one pharmacy that can dispense it, and there is a program associated with it... It is very controlled and seems to be really effective for a lot of people. They also have a program to pay for whatever your insurance doesn't cover or if you don't have insurance. Good Luck.

Tomi L avatar

Tomi L

I Live In Finland and find that over the world the policies are similar. However, there is one med not mentioned at all. Voxra, zyban, wellbutrin(trade names) . Some are getting great results with this, despite this being for a depression treatment (without being depressed) . It has effect on fatigue also, not for everyone - but still worth trying.

More Awake avatar

More Awake

Yes. This has helped me as my insurer won't pay for Provigil yet. I like that it doesn't seem to have side effects.

Johnymac avatar


I live in Australia. I have been diagnosed with ppm since 2016, since then I have lost my job, my walking ability. I have tried many different medications none of them have been any benefit matter of fact quite the opposite. Amantadine being the last. My fatigue gets worse by the day. We are fortunate in this country in that we have the ndis that helps ms people with providers and equipment. The latest being an in house hoist just looking at the thing sent me into depression for two days. There just doesn't seem to be a way to slow this thing down. I have enjoyed reading the comments.

ModAus avatar


multiple sclerosis is something I dont take lightly, I cant imagine the pain that those who suffer from this. Ill be sharing this website if mine is allowed. Thank you

Michelle Benoit avatar

Michelle Benoit

I also have CVS Caremark as my prescription provider. I was just prescribed Provigil by my neuro, but they insisted I try Amantadine first. Day 1- I felt like my pain was amplified, and slept literally all day. Day 2- my pain was still amplified but I figured if I made myself get up and go out into the world it would be better. Big mistake! I was more irritable than I have ever been in my life! I would go from anger to crying in the blink of an eye. Not only was I emotional, I could only feel negative emotion. My body is screaming in pain, much worse than I’m used to, which says something because I have both MS and fibromyalgia.

I have stopped taking the Amantadine and asked my doctor for the provigil. I’m hoping that CVS will approve it in all their wisdom. Otherwise, I’m just stuck.

I’ve had a question ever since CVS took over my prescription coverage... how is this even legal? Doesn’t it show a huge conflict of interest when the giant chain pharmacy controls what prescription your doctor can give you? I’m sure I’m not the only one who has a problem with this.

Mary avatar


Does CVS decide what you can take, or does that decision begin with your medical insurance provider?
If your pain is MS nerve pain, have you ever tried Cymbalta or Neurontin. Both are used off label to treat nerve pain and provide some relief for mine. Best of luck.

Nadine Maciejewski avatar

Nadine Maciejewski

I've had MS for 46 years. Thank God, in all that time my only big problem was the fatigue which was really bad. I was prescribed Provigil and I call it my miracle drug. I'm 72 years old now and my balance has become a big problem now also. I had Gateway Medicare Health Assured for insurance which covered all my mrdications without a problem. However, their hospital coverage didn't start covering you until you were in your fifth day. For that reason I changed to UPMC. Oh whoa, coverage on my medicine co-pay was wonderful. Most of my meds had no co=pat at all. I started the plan in December; It is now March. My doctor had to submit a new pre-authorization for my Provigil.I found out why most of the drugs I take don't have co-pays. They denied his request and informed him I had to use Amantadine for two full months because IT WAS SAID Amantadine showed it treated the fatigue for fatigue also. So without my say they sent my pharmacy the script Amantadine instead of Provigil. I'm not stupid, the first thing I thought of was it must be cheaper. I told my doctor I refused to take it because I'm a firm believer in if it's not broke, why fix it. Why should I take a drug THAT'S SAID TO HELP, when I know a drug that DEFINITY HELPS. I called UPMC Member Services and told them just that. They told me to have my doctor send another pre-aothorization request explaining I refuse to take the drug and why and to back up my refusal. My big question is, (I haven't thought about it until just now is) if I take something used for a different disease and it doesn't work for my fatigue will I then be granted my Provigil. The other thing that's frightening me is when I went to my doctor my balance is so bad and deteriorated so quickly, my docoter ordered me to have an MRI of my brain and spinal column to see if my MS has progressed more. I live alone and I can't even amagine walking around like a sleep deprived drunk. I don't know what to do!

modafinil avatar


I have been using modafinil for a few years now and it makes me focused on my work and studies.

Nancy U. avatar

Nancy U.

Supposibly synergistic supplements and amino acids include acetyl l-carnitine, choline, inositol, l-tyrosine, alpha lipoic acid and 5-htp. I tried these out for about a month with DMAE and noticed a surge in productivity, less “brain fog,” a decrease in the urge to procrastinate and concentration. But provigil (Modafinil) definitely works much better for me. Very glad ? I googled ‘Uniso2slp’ and got it. At work, I was able to focus on tasks amazingly well…the day flew by and I was able to multi-task and get a lot done, more than I would have, and it wasn’t as emotionally draining. I didn’t have to motivate myself to do the work.

However you should notice Modafinil enhancing your awareness for almost a full day, allowing you to focus and think more indepthly. Modafinil keeps me awake and alert all day. It makes it easier to multitask. For me, the effect is very noticeable that I've taken something. Modafinil has been more beneficial to me personally. I absolutely loved it. It gave me a clean, sharp focus. Coming down was light and barely noticeable.

Ian H. avatar

Ian H.

I was on Amantadine for a couple of years, it helped with my mobility but the "Brain Fog" was getting worse so my neurologist changed me to Modafinil.
After a week of coming off the Amantadine and starting the Modafinil I was unable to walk more than 10mt, but I could think.
It took some robust negotiating with my neurologist, but I am now taking Modafinil AND Amantadine without any obvious side effects. I only need to take one Modafinil tablet in the morning usually, if I know I'm going to have a long or busy day I might take a second one at midday. My ability to walk improved within days of restarting the Amantadine.
It seems the Amantadine helps with mobility and the Modafinil helps with cognition.
Although both drugs are used individually off-label for MS fatigue the combination was not offered to me, I was given an either/or option between the two drugs, so either be a walking zombie, or immobile but able to think, neither of which would allow me to continue working.
The combination may not work for everyone but it certainly makes a big difference to me, I'm able to keep working.

AC avatar


Wow! I’ve been on Amantadine for 2+ years and has helped. However I still felt tired sometimes and napped everyday. Switching to Modafinil and currently on day 2. Terrible brain fog is back. Weird headache like feel and off balance so far. Dr. wants to give it at least 1-2 weeks before I change dosage, etc. Feel like it’s 2 steps back from my normal Amantadine. Sure hope this works cause I feel like dizzy, wobbly fool.


Leave a comment

Fill in the required fields to post. Your email address will not be published.

Dancing Doodle

Did you know some of the news and columns on Multiple Sclerosis News Today are recorded and available for listening on SoundCloud? These audio news stories give our readers an alternative option for accessing information important for them.

Listen Here