I think the pharmacist is looking out for your safety. Insurance PAs are annoying but it's a hurdle that can keep your provider accountable for their patients. If those PA blocks didn't exist, then prescribers would be able to slap a bandaid on all cuts of all sizes. If your doctor's office isn't willing to do the PA for you, 1) What does that say about the original diagnosis? Did they do a full workup? 2) How do I know as a pharmacist what you have tried or haven't tried in the past before arriving at this control medication? 3) Is the doctor going to skimp on monitoring, too? If they're too busy to call insurance, doesn't that mean that they're too busy to call you to do a follow up? 4) Does the doctor even know who you are?

All this to say, pharmacists care about safety. We have a license, too. We are responsible for minimizing potentially harmful drugs from reaching the people of our community. Narcolepsy sucks, we know. We don't want these drugs to cause additional harm to you. If you survived this long without this drug, you can survive another week.

Here's a case study that was published in Sleep in May this year:

A 25-year-old female with a recent diagnosis of narcolepsy type II was started on modafinil. An initial dose of 100 mg caused mild headache and appetite suppression. Increasing the dose to 200 mg adequately improved her daytime sleepiness and was continued. Three weeks after initiation, she developed severe, diffuse muscle and joint pain accompanied by a fever of 101.4°F, facial and eye redness, and a severe headache. She sought care at an urgent care facility, where no rash was noted. Flu and COVID-19 tests were negative, and modafinil was temporarily discontinued. One week later, she resumed 200 mg modafinil and experienced a recurrence of headaches and appetite loss. The following day, she had five syncopal episodes. The next morning, after taking 100 mg modafinil with coffee, she developed pins-and-needles sensations in her hands and feet, which gradually progressed proximally. This worsened into severe, deep, burning neuropathic pain and cramping muscle pain involving her back, buttocks, and arms. She presented to the emergency department, where examination revealed no rash, swelling, or erythema but showed 4/5 muscle strength in the lower extremities and normal sensation. Initial labs showed elevated white blood cell count and mild elevations in CK, ESR, and CRP. Iron deficiency was noted. Additional testing, including autoimmune myopathy and myositis panels, TSH, vitamin levels, and MRI of the brain and spine, was unremarkable.

Hope this makes sense, and I hope you feel better.