Cats x 3
05-21-2005, 06:08 PM
I hope someone can help me with this question. First let me say that the Duragesic has been working great. I had a L4-5 Fusion in 1992. In 1995 had all the hardware taken out. I just started pain management 2 years ago after trying everything else out there. I take Duragesic 75 and Norco 10mg for break thru pain. Here is the problem. I am paying $110.00 per month for the Duragesic. I know you are saying if it is " working great" then what is the problem, well the problem is I can't afford this every month on top of everything else. I have Insurance and an Rx card. This is my Co-pay. The Rx Company said to buy generic, my PM will not give me the generic and always writes Brand Ness. on the Rx. The pharmacist said he has to fill it with Brand name. What else could I take that would be like the Patch but cheaper??
Any thoughts or help would be greatly appreciated. Thanks in advance.
Debbie
Any thoughts or help would be greatly appreciated. Thanks in advance.
Debbie
Sponsor
mkmb75
05-21-2005, 07:38 PM
My co-pay (I change every 48 hours, thus I have to have 3 boxes) is $50 per box on Duragesic. I just today went and traded in the MYLAN boxes of generic because they DO NOT WORK for the name-brand. I know they are expensive, but they are all that help me, so I have to pay for it. The pharmacist said they were about $100 a box without insurance. I don't know of anything else, but I am so new to this, I am interested to know also if there is anything comprable to the patch but less expensive. I hope there is, b/c $150 a month for 1 medication is draining to our monthly budget also.
Good luck,
Mary Kay
PS I forgot to mention, the MYLAN generic is not worth the $$ you save - I went thru all my BT meds thinking I was just having a bad flare-up, but the patch is SO thin, you can't see any medication in it, so I think it was just not working. I have heard that the SANDOZ generic is better, but none of my pharmacies carry it. I thought it was just me, but it has been mentioned before that the MYLAN generic is bad.
Good luck,
Mary Kay
PS I forgot to mention, the MYLAN generic is not worth the $$ you save - I went thru all my BT meds thinking I was just having a bad flare-up, but the patch is SO thin, you can't see any medication in it, so I think it was just not working. I have heard that the SANDOZ generic is better, but none of my pharmacies carry it. I thought it was just me, but it has been mentioned before that the MYLAN generic is bad.
littlejmb
05-21-2005, 07:41 PM
You are right - the Mylan generic is WORTHLESS - but through these boards, I found out that Sandoz makes a generic also, and is just like the original Duragesic patch. My husband tried the Mylan first because that is what our pharmacy carries, but when I found out about the3 Sandoz, they ordered them for us, and he says they work just as well as the name brand. Perhaps you can give them a try.
Shoreline
05-21-2005, 07:45 PM
Hi Debbie, It's nice to se a doc that recognizeds all roducts are not equal, The generics simply have to meet a standard range that the proprietay drug reaches. The samne dose won'rtt create the same serum level in everyone, size, blood volume and metabolism all effect it so uou end up with give or take +20 or -20% when creating a generic. I hope he allws you t use the geenric norco, necause the same manufacturer makes both the generic and athe name brand product Your going to get aabot as close as you would from one batch to the next if your sticking with the same manufacturrs, just a different food coloering and imprint stamp in one Vs the other.
It seems allowing you to try a generic is less difficult than starting all over with a new med btut there are charts that can guide a doc into the right ballpark, but the ballpark may b large and take a few adjustmnents to get the same rlief, plus it may take more of one drug t o provide qual reief than another despite what all charts say.
Durageis is likely a tier 1, having the most expensive copay, MSContin has been aound the since 84 and if he's stuck on generic you would be in the 225-315 mgss per day range, or he could use Kadian or Avinza which likely are hifgher tier meds than the oldr MSC. Th last two are also true 12 hour meds that last u tp 24 hours
40-60 mgs of methadone even cash for brand name a day would cost you less than 115 a month, It's dirt cheap but has it's own unique properties.
Demerol isn't an option, due to metabolte build up.
Oxtcontin would be an option in the 120-160 range and is 9 years old. hopeflly not the most expensive tier.
Palladone, the new LA dilaudid is now available, the manufacturers guideline is rediculosly low so it would probably take alot of adjustmets to get to a working dose around 30-40 mgs a day. Likely top tier and all the name brand are expensive, but hopefully not to the extent of what your paying and you will spend making adjustments.
These numbers are just guides, there is no absolute conversin ratio you can use on everyone, so docs tend to start low but should expect and plan to see you more frequently untill the dose is adjusted correctly and side effects are managed or have time to deminish. There are 3 distinct families of opiates represented in the ones I mentioned and none are in the unique class that the fents are in.
So it's a big change and some differential withdrawal, milder than normal withdrawal, may take time to transition through as you find the right dose if you don't taper down on the fentanyl and do a cold switch like so many docs do.
Good luck, those are the US options, His rationale for name only may be that he doesn't have to prescribe as many lgs of an inferir product, but not all generics are inferior.
Take care, Dave
It seems allowing you to try a generic is less difficult than starting all over with a new med btut there are charts that can guide a doc into the right ballpark, but the ballpark may b large and take a few adjustmnents to get the same rlief, plus it may take more of one drug t o provide qual reief than another despite what all charts say.
Durageis is likely a tier 1, having the most expensive copay, MSContin has been aound the since 84 and if he's stuck on generic you would be in the 225-315 mgss per day range, or he could use Kadian or Avinza which likely are hifgher tier meds than the oldr MSC. Th last two are also true 12 hour meds that last u tp 24 hours
40-60 mgs of methadone even cash for brand name a day would cost you less than 115 a month, It's dirt cheap but has it's own unique properties.
Demerol isn't an option, due to metabolte build up.
Oxtcontin would be an option in the 120-160 range and is 9 years old. hopeflly not the most expensive tier.
Palladone, the new LA dilaudid is now available, the manufacturers guideline is rediculosly low so it would probably take alot of adjustmets to get to a working dose around 30-40 mgs a day. Likely top tier and all the name brand are expensive, but hopefully not to the extent of what your paying and you will spend making adjustments.
These numbers are just guides, there is no absolute conversin ratio you can use on everyone, so docs tend to start low but should expect and plan to see you more frequently untill the dose is adjusted correctly and side effects are managed or have time to deminish. There are 3 distinct families of opiates represented in the ones I mentioned and none are in the unique class that the fents are in.
So it's a big change and some differential withdrawal, milder than normal withdrawal, may take time to transition through as you find the right dose if you don't taper down on the fentanyl and do a cold switch like so many docs do.
Good luck, those are the US options, His rationale for name only may be that he doesn't have to prescribe as many lgs of an inferir product, but not all generics are inferior.
Take care, Dave
Cats x 3
05-21-2005, 07:52 PM
Hi, I have heard also that the generic Mylan patch is not good. I have been calling around looking for the Sandoz but, no one carries them and my Mom & Pop pharmacy said we "don't have a contract with them" and would not order them. It doesn't matter now since my PM dr. will not write it for generic.
I am just thankful that I have pain management now. I went thru so much as I am sure you both did before I could even get into pain management. I think I will just suck it up and stay with the name brand patches since they work. It would be awlful to change to something else and have side effects.
My PM said patients were coming back to him with the Mylan patches and wanting a new rx to get the name brand. Around here pharmacies will not let you bring back medicine. He said it is an inferior product and should be taken off the market. So, I will just be thankful that I have something that works. If you don't mind me asking, what if anything do you take for break thru pain?
I am just thankful that I have pain management now. I went thru so much as I am sure you both did before I could even get into pain management. I think I will just suck it up and stay with the name brand patches since they work. It would be awlful to change to something else and have side effects.
My PM said patients were coming back to him with the Mylan patches and wanting a new rx to get the name brand. Around here pharmacies will not let you bring back medicine. He said it is an inferior product and should be taken off the market. So, I will just be thankful that I have something that works. If you don't mind me asking, what if anything do you take for break thru pain?
mkmb75
05-21-2005, 08:13 PM
If you are asking me, I am only taking Tylenol #4 for BT pain. I can take 2, but usually 1 will do it. I used to take Darvocet N-100 for my Fibro, and couldn't get anything stronger, so I really haven't HAD too much BT pain (Thank God) yet with the Duragesic, but I do have to change it every 48 rather than 72 hours. I was given the option of going up to the 75 mg patches but didn't want to do that yet as then I wouldn't have too far to go before I topped out that med. I am just beginning this journey with stronger meds, and am so thankful that my GP will give me the Duragesic. I have lived with the fibro for years before I was dx'ed, took all the normal NSAIDS and they didn't work, etc.
I have had great success with the patch, my only complaint is some nausea, for that they gave me Compazine and then Zofran (which I try not to take as it is so strong), and of course the cost. I hope it continues to work, and hopefully my pharmacy where we are moving will be willing to order the SANDOZ brand.
Good luck, I have found so many good answers to many questions here!
Mary Kay
I have had great success with the patch, my only complaint is some nausea, for that they gave me Compazine and then Zofran (which I try not to take as it is so strong), and of course the cost. I hope it continues to work, and hopefully my pharmacy where we are moving will be willing to order the SANDOZ brand.
Good luck, I have found so many good answers to many questions here!
Mary Kay
Cats x 3
05-21-2005, 08:29 PM
Shoreline thank you for all the great information and for all the feed back from everyone. I was worried that there would be nothing like the patch I could go to without getting into side effects and the Duragesic gives me no side effects. Yes my PM dr does allow generic on the Norco. He just doesn't like the generic Duragesic. I guess it is a blessing that he did not write it for generic because I have read so much on the boards about the generic. At least this proves he listens to his patients or he would not know about the problems with the generic. He is very strict and you have to hold your head just right or you are kicked out of his clinic. I only see him every 3 months that is $136.00 and then I have to go in every 30 days to see the nurse and thats just $36.00. But then you add the medicinie and that adds up.He will not post date anything and there are no early refills. But at least I know he will be treating me for a while as long as he jumps thru all the hoops he is supposed to. I think I would rather have a strict one to be honest. Thank you all for responding to my post.
Debbie
Debbie
Cats x 3
05-21-2005, 09:00 PM
Mary Kay, Does the patch work better for you changing it every 48 hours? The reason I am asking is because I told my Dr it only lasted about 60 hours and asked if I could change it in 48 hours?? He said no and increased it from 50mcg to 75mcg. I'm sorry but if it does not last, how is increasing it going to work better? it still wears off after 60 hours. I have to use too much break thru medicine if you are only using a few Tylenol #4. Did you just tell him it wasn't lasting the full 3 days?
Thanks,
Debbie
Thanks,
Debbie
Director
05-22-2005, 12:04 AM
Hey Cats,
This is a simple solution. Methadone!! It's cheap and effective. Give it a try. I'm on it and it works great and I have been on the Duragesic patch too!!
This is a simple solution. Methadone!! It's cheap and effective. Give it a try. I'm on it and it works great and I have been on the Duragesic patch too!!
goawaypain
05-22-2005, 09:33 AM
Hey tell your doc that the Sandoz generic patch is made by the same company that makes Duragesic. They are the SAME patch, made same place, etc. They had to come up with their own generic so they could compete against the Mylan one. Maybe your doc doesn't know this, tell him, and from what I have heard you should get the same relief from the Sandoz as from the brand. Just my thoughts on this.
Sorry you have to go thru this, I am in the same boat. I am on Avinza 60mg, 1x a day and my co pay on this is 50 $ a month. All the rest I get from my insurances mail order and it is a lot cheaper. I do know some companies (insurance will allow you to get 3 months at a time, even though they are class 2 drugs, that just have to have rx, and phone call from doc.
Maybe you could call your insur. co. and ask them about it, and price for 3 months, and then ask your doc.
Take care and I hope you get some answers soon as this kind of crap just fuels our pain.
Sorry you have to go thru this, I am in the same boat. I am on Avinza 60mg, 1x a day and my co pay on this is 50 $ a month. All the rest I get from my insurances mail order and it is a lot cheaper. I do know some companies (insurance will allow you to get 3 months at a time, even though they are class 2 drugs, that just have to have rx, and phone call from doc.
Maybe you could call your insur. co. and ask them about it, and price for 3 months, and then ask your doc.
Take care and I hope you get some answers soon as this kind of crap just fuels our pain.
Cats x 3
05-22-2005, 12:14 PM
Hi Director and Goawaypain, Those were great ideas and thank you for posting. I don't think I can get the mail order because my PM Dr. will only write the Duragesic for one month and will not write post dated rx's. I'll ask and see what he says. Great idea! And Director, how much Methadone would I need to go from the Duragesic to Methadone?
Debbie
Debbie
Director
05-22-2005, 11:31 PM
Hi Debbie,
It's not how much Methadone you'd need to make the switch, it's what your doctor will prescribe. Meth is a very strong pain med and usually docs will start you low, some where in the neighborhood of 10 mg per day. Yours might start you a little higher since you were on the 75 patches, but remember, they will bump you up fairly quickly once you've acheived the serum level in your blood stream at about five days. You may experience some mild withdrawal.
I am on Methadone and have been for a couple years. I'm at 180 mg, but I have a high tolerance and my doctor knew it, so he increased my dose rather quickly. As far as you, I would guess you'll need somewhere around 80 mg. maybe a little more. It's really hard to say. Meth is a very good pain med and it was developed by the Germans during WWII when their supply of morphine became very low, so it's been around for a long time.
I'd be very interested in hearing what your doctor has to say when you present this to him. Remember, Meth is very cheap. In fact, you would probably be able to pay for it without any insurance coverage. I get 540, 10 mg tabs a month, but I have a co-pay of $15.
Good luck to you with your doctor.
It's not how much Methadone you'd need to make the switch, it's what your doctor will prescribe. Meth is a very strong pain med and usually docs will start you low, some where in the neighborhood of 10 mg per day. Yours might start you a little higher since you were on the 75 patches, but remember, they will bump you up fairly quickly once you've acheived the serum level in your blood stream at about five days. You may experience some mild withdrawal.
I am on Methadone and have been for a couple years. I'm at 180 mg, but I have a high tolerance and my doctor knew it, so he increased my dose rather quickly. As far as you, I would guess you'll need somewhere around 80 mg. maybe a little more. It's really hard to say. Meth is a very good pain med and it was developed by the Germans during WWII when their supply of morphine became very low, so it's been around for a long time.
I'd be very interested in hearing what your doctor has to say when you present this to him. Remember, Meth is very cheap. In fact, you would probably be able to pay for it without any insurance coverage. I get 540, 10 mg tabs a month, but I have a co-pay of $15.
Good luck to you with your doctor.
sgibson
05-23-2005, 02:18 PM
Hmmm... As far as the Sandoz patch goes, I have been on Duragesic for 3 years. I got the Sandoz patches last month. (In the same strength I was on) I went through two weeks of somewhat mild withdrawal and also had an allergic reaction to the adhesive. I never had any trouble with the brand name patches. My doctor said that obviously there is a different adhesive on this patch and the formulation of the medicine is somewhat different causing me to go through withdrawals. We all react differently to our meds. Your mileage may vary greatly from mine. If Jannsen is making the Sandoz patches, maybe they cut corners on the generic formulation... ie: using cheaper adhesive and possibly lower quality fentanyl.... Just my opinion.
God Bless,
Sherry :wave:
God Bless,
Sherry :wave:
Director
05-23-2005, 02:19 PM
Hey Debbie...I had some thoughts last night after I wrote the previous post. If you would change over to the Methadone, the best way would be to stay on the Duragesic (Fentenyl) while the Methadone is started and increased. When the Methadone increases, the Duragesic is decreased. That way, you shouldn't have any withdrawls. If you do, they would be very mild. I just wanted to make sure you understood that part of the transistion.
Another way to do it, is to have your doctor write a script for some short acting meds to supplement the Methadone. Something like Oxycodone or Dilaudid would help you a lot during the change over. Hydrocodone would probably help, but the Class II drugs would be better for you. After about day five on Methadone, you can up the dose by about 10 mg a day, every three days or so.
Another way to do it, is to have your doctor write a script for some short acting meds to supplement the Methadone. Something like Oxycodone or Dilaudid would help you a lot during the change over. Hydrocodone would probably help, but the Class II drugs would be better for you. After about day five on Methadone, you can up the dose by about 10 mg a day, every three days or so.
mkmb75
05-26-2005, 04:13 PM
Hi Debbie,
Sorry I am late in getting back to you. My doc offered to up me to 75's but I said no, and he allows me to change every 48 hours vs 72. Mine quit working about hour 45 or so. I didn't want to bump up b/c then I'd not have far to go beofore I topped out. I am going to aks for something stronger than T #4 when I go back, tho, and my BT pain is getting worse. But now that I change every 48 hours, my pain is much better.
Good luck!
Mary Kay
Sorry I am late in getting back to you. My doc offered to up me to 75's but I said no, and he allows me to change every 48 hours vs 72. Mine quit working about hour 45 or so. I didn't want to bump up b/c then I'd not have far to go beofore I topped out. I am going to aks for something stronger than T #4 when I go back, tho, and my BT pain is getting worse. But now that I change every 48 hours, my pain is much better.
Good luck!
Mary Kay
dango
05-30-2005, 10:06 PM
All I have to say--is that in my state the pharmacy said the M.D. had to document a full trial of FAILURE of treatment w/the generic--meaning a month or two--before the Pharmacy COULD fill the "NAME BRAND ONLY" prescription. Then she handed me some form that showed state law to that effect. Thus I went OFF the patch when the generic came out and it did NOT last more than maybe 36 hours. When I WAS using the Fentanyl patch--I used percocet (i.e. oxycodone) 10/325 up to 3x daily for break through!
journalist
05-31-2005, 03:11 AM
You are right - the Mylan generic is WORTHLESS - but through these boards, I found out that Sandoz makes a generic also, and is just like the original Duragesic patch. My husband tried the Mylan first because that is what our pharmacy carries, but when I found out about the3 Sandoz, they ordered them for us, and he says they work just as well as the name brand. Perhaps you can give them a try.
journalist
05-31-2005, 03:13 AM
Thank you so much for the Mylan info..my husband's pain management doctor switched him to generic (at our request) to save a little, and his pain has been out of control this past month. He has an appointment day after tomorrow and this is so good to know. I really appreciate these boards.
StMishl
05-31-2005, 04:34 PM
FYI I found the Sanchoz patches... Target (the big "has-everything" store) carries them as their only generic in their pharmacy! I called around and found them there (after becoming very frustrated that none of the Walgreens, Oscos, etc, had them)... I found they work MUCH better then the Mylans!
Good luck!
-Michelle :bouncing:
Good luck!
-Michelle :bouncing: