Below, please write down the Total Amount Paid for Provigil or generic versions of Provigil (Modafinil) from
June 24, 2006 through August 8, 2019 for prescriptions filled in the following
Alabama, Arizona, California, District of Columbia, Florida, Hawaii, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine,
Massachusetts, Michigan, Minnesota, Mississippi, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota,
South Dakota, Tennessee, Utah, Vermont, West Virginia and Wisconsin.
(For mail order purchases, the state of residence of the patient is deemed to be state in which the purchase
A Claimant “paid” for Provigil or generic versions of Provigil (Modafinil) if, for example, the Claimant had insurance and
paid a co-payment or a co-insurance payment (that is, the Claimant's unreimbursed out-of-pocket cost) and insurance covered
the rest. Also, an insured Claimant may have “paid” for the drug if she paid for the entire cost of the drug because the
Claimant had not met a deductible. A Claimant not covered by insurance who purchased the drug would also be considered to
have “paid” for the drug.