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Old 12-15-2010, 04:31 PM   #1
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Exclamation Switching from Kadian to ???

Due to changes in my insurance co-pay I will be financially forced off Kadian 100mg x3 daily next year. I have been stable on this dose for 4-5 years. I have even lowered my Kadian dose and had wounderful success with Cymbalta (30mg x3)the past few years. This one as well is not available as a generic so I proibably need to explore other options here as well.
From what I have been reading here it sounds like MScontin will be the closest match to the Kadian. Has anyone made this switch and are there any potential problems I should be wary of? Any other suggestions for this switch? How about altenatives to the Cymbalta? A pharmacist mentioned EffexorXR. ???

BTW I have RSD in both feet going on 8 years and have been leading a fairly normal life since I have been stable.

 
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Old 12-18-2010, 11:18 AM   #2
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Re: Switching from Kadian to ???

I'm sorry to hear this Lloyd. I have been worried about getting kicked off my Kadian, too. When I first started taking it I had to pay out of pocket and it was $175 per month. For the past 2 years, my insurance has covered it, but I have noticed that the cash price has been creeping up and last month the pharmacy slip said "your insurance saved you $597.99" I was floored! $625 for one month? Unreal. I better check my insurance to see if it's still covered in 2011. There is no way I could pay for this out of pocket, and for me the generic MS contin didn't manage my pain nearly at all compared to the Kadian.

Effexor is a good substitute for Cymbalta. They both have the same brian mechanisms. But IMHO, generic MS contin is NOT the same as Kadian.

 
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Old 12-18-2010, 05:58 PM   #3
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Re: Switching from Kadian to ???

Thank you Toonces1, my dose of Kadian in my market is $1452, my share would be 30% of that monthly on top of my Cymbalta. After hearing your experience maybe I should look into an implanted pump.
I hear that the Effexor is the same just as you indicated. Have you had any personal experience with either?
Cigna also claims Cymbalta is $1400 and change as well. My portion once again will be 30% of that UNLESS I can find a generic alternative. Oh and did I mention they gave me almost a 20% monthly bump so my out of pocket monthly would be roughly $2,000.00.
I guess I didn’t realize how good I had it.

Anyone else have some ideas? HELP.

 
Old 12-18-2010, 08:50 PM   #4
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Re: Switching from Kadian to ???

Wow that really sucks. I have taken Effexor for over 10 years. I started back when it was just regular Effexor and then switched to XR when that became available. I didn't really notice a difference between the reg and the XR. I had very severe depression for about a year and tried many other medications and this was the only one that worked. I did talked to my doctor after my injury about taking Cymbalta for the pain management effects, and she said that Effexor was probably going to have the same effect that Cymbalta did. There is a new generic version called venlafaxine ER or CR or something like that. My husband takes it and is happy with it. For some reason my insurance keeps filling mine with the brand name, but my doctor said the switch to generic would be fine. I would say that of all my medications, Effexor changed my life the most. The Kadian is a close second, though. The only drawback is you can't miss a day because it has a short half-life (even the XR) and the withdrawals are pretty crazy (I get vertigo and can't drive if I forget to take it).

I don't know what to do about the Kadian. I went on it because it was the only brand name extended morphine that my insurance covered at the time. But as I said, it was much cheaper then. It is so stupid for them to raise the price so high, because all of us are going to stop buying it because our insurance dumps it. I tried to go on my 2011 insurance website today to see if it was covered, but I couldn't find the info. I would (and do) take generic of just about anything (except the Effexor) but I can't do the generic MS contin. If I have to go on that, I'm going to ask my doctor to raise my dose. I was on 60 mgs of Kadian and then switched to 60 mgs of MS contin (generic) a few years ago for a couple months, but it was like night and day. I was taking the MS contin over 3 doses per day and it still wore off after about 4 hours. It's really a bummer. I will probably ask to dose 4x/day if I have to switch. Maybe you could think about asking your doc for the same. I really think the Kadian is so slow and steady, that's what makes the difference.

BTW - I THINK Avinza is also a long-acting morphine. Maybe it's worth it to check to see if that's covered or any cheaper. GOOD LUCK. Let me know what happens.

 
Old 12-19-2010, 12:19 AM   #5
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Re: Switching from Kadian to ???

Nortriptyline would be a cheap and effective substitute for Cumbalta, and comes in at around $5 per month.
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Old 12-19-2010, 06:10 AM   #6
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Re: Switching from Kadian to ???

Hi Loyd, I found my self in the same position before I had the pump implanted. I was taking 200 mgs 3 times a day and just switched to the generic version of mscontin and took 200 of it 3 times a daay. It was the smoothest transition I ever had. Now from that to methadone and back, that wasn't so smooth. But morphine is morphine.
Good luck, Dave

 
Old 12-19-2010, 08:15 PM   #7
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Re: Switching from Kadian to ???

The prices American companies get away with charging for drugs absolutly amazes me.... proces for those drugs in Australia would be much less than a quater of what you pay, and with out national insurance scheme, the maximum anyone has to pay for a script is 33 dollars for a months suppkly
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Old 12-19-2010, 08:23 PM   #8
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Re: Switching from Kadian to ???

Johnstar,

You guys definitely have it made there. My MSContin here in the states without insurance for a 1 month supply, which is 120 pills, is $195.00, with my insurance it's only $3.00. I don't see how people without insurance, even bad insurance make it. But I can honestly say, I'd rather pay out of my pocket than have a nationalized insurance scheme, and the government thinking they have the right to govern my medical care.

kat

 
Old 12-20-2010, 03:04 AM   #9
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Re: Switching from Kadian to ???

Our national health scheme isnt quite like that, its still private medicine, but the fees are partly rebated by the government..... I go to the doctor of my choice, pay him, and then claim back most of his fee from the insurance commission. I can see any doctor I want as many times as i want.

With drugs, there is a list of drugs the government subsidises (a formulary, like US insurance companies have) and because they are buying for 22 million people, they can drive a hard bargain. Virtualy all usefull drugs are on the list, for a few that arnt, you can have them prescribed privatly. There is also private medical insurance for those who prefer it.
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Old 12-20-2010, 06:10 AM   #10
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Re: Switching from Kadian to ???

Do they have ms contin in australia? I do not think they give morphine to people in Australia katlin, as far as I know due to addiction issues. THey are very careful over there. You might pay out of your pocke katlin but at least you can get the meds you want. so far they allow ms contin in the u.s imagine they do what they have done with the oxycontin.

 
Old 12-21-2010, 12:30 AM   #11
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Re: Switching from Kadian to ???

Quote:
Originally Posted by nochange View Post
Do they have ms contin in australia?

Yes, we do, we even have electricity now, and we're hoping to get television within the next year or so.

We also have Oxycontin, Dilaudid, and all the other common analgesics. Kadin was actualy developed by an Australian drug company based in my town.

Because medicinal narcotics are controlled here by the health department, rather than a police agency ( the DEA ), I think we actualy have a more liberal system than the US so far as narcotic prescribing goes.

What do they know of America, who only America know?
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Old 12-21-2010, 03:30 PM   #12
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Re: Switching from Kadian to ???

Just keep in mind that noritriptyline is a tricyclic antidepressant, which in my opinion had way more unpleasant side effects that the SNRIs (i.e Cymbalta, Effexor, pristique). The newer SNRIs are generally much more popular because of very low side effects, but if you are really struggling financially and SNRIs aren't covered, I have had some help from tricyclics, but you would definitely want to take a week or two to see how you react to it. I passed out a few times when I was on tricyclics, and my mouth was so dry I had to constantly be sucking on a piece of candy.

 
Old 12-21-2010, 04:06 PM   #13
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Re: Switching from Kadian to ???

Hey Jon! I agree with you on the prices and how crazy they are here in the US. I've been on oxycontin for quite awhile and on the old version, I used to see the cost at around $1,300 for month supply. Then came the new (and better version HAHAHAHA!) OP and I noticed that they were charging the insurance company close to $1,800 a month. UFB!! There has to be something that can be done, but I have no idea what it is. My best to all!
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Old 12-21-2010, 04:19 PM   #14
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Re: Switching from Kadian to ???

what can be done, is that we Americans can all move to Canada, Australia, or the UK.

 
Old 12-21-2010, 10:17 PM   #15
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Re: Switching from Kadian to ???

Toonces, you do not want to move to England trust me. They have national health care but they do not care much for pain control. I have seen that in our forum.
they mostly rx you tramadol extended release, rarely oxycontin etc.It is not that great. They are afraid of addiction.

As for Canada, never been there, I do not know how the system works.
I know the weather is humid, so it is not so good when you have pain.

And Australia, John said it's great. So who knows? I have family there but they do not suffer from chronic pain.

As for T.V and electricity. Of course I know they have those in australia. how can you use the internet;;;;;;;well, that is the australien sense of humor. I have met a few in the past and my family over there of course. You do not have the american sense of humor there, so watch out....but the australien weather is good for the pain, most of the inland is dry.
I wonder if it is like arizona and nevada? anybody knows?

No more suffering. Doctors, leave us alone this year.
Merry Christmas everybody

Last edited by nochange; 12-22-2010 at 09:04 AM.

 
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