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Old 09-01-2012, 03:55 PM   #1
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Self Pay Price of Fentanyl vs ???

I currently use a 25 mcg Fentanyl patch every 72 hours, I don't have insurance and self pay all my scripts. This is the first month I've used them and I have kinda of a love/hate relationship with them....I like that they kill the hills and valleys/ups and downs between BT pain. To the point though, I have noticed in the past month that day 3 the efficacy drops off drastically. I have my next appointment with my doc in a week and was going to inquire about switching to a 48 hour schedule, which of course, would add 5 more patches a month to my RX. That would make my cost about $150 straight out of my pocket...and I'm sure he will want me to give the patches at least another month at a 48 hour change schedule before trying a different LA med, but my question is this:

When we settled on the patch last month (because it was most cost effective for me) we had also batted around the idea of methadone, oxycontin, and I guess its either MS Contin or Avinza maybe...? But does anyone know, who may self pay, 1- what an equivalent does of methadone, OC, or Avinza would be and 2- about how much that dose/monthly amount would cost (approximately) of course?

OH! I also work as a chef doing very physical work (have been for 10 years, no career change in sight) and it tends to get HOT! I know this is bad news for the patch and have had at least one instance of light headed-ness, does anyone think this is reason enough in itself to stray from the Fentanyl patch?

I understand no one here is a doctor or pharmacist but any info would be HIGHLY appreciated! I guessing, off hand, methadone would be the most cost effective but I know nothing about it cost wise or what an equal dose/amount would be with regard to a 25mcg patch (48 switch).

Thanks again...everyone here is so extremely helpful...hope I can get at least some kind of rough idea, if not cost, but what equal doses of the three different medications would be.

....and of course these are things to be discussed with my doctor, I know. I tend to try to garner as much information for myself and make lists of notes/questions/concerns to take to my appointments so I never go to an appointment blindly.

Also, while I've got you on the hook (LOL) I want to start a habit of making a pain diary- what are/is the best way to compose this?

Thank you all again in advance!

 
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Old 09-01-2012, 08:53 PM   #2
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Re: Self Pay Price of Fentanyl vs ???

Hi! I hope I can help!! I'm currently self pay taking methadone 45 mg a day. According to an opioid conversion calculator, this translates to about 35 mcg of fentanyl which I know is slightly higher than the dose you are taking. But my monthly cost is about $30. That would be a lot cheaper than what you pay now. I've never taken fentanyl, but was on morphine before this, and this works so much better for me than the morphine. My doctor told me that methadone hits more pain receptors than most other narcotics, and that's why a lot of patients get the best pain relief on methadone.
I hope you find what works for you! Good luck, and keep us posted!!

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Old 09-01-2012, 09:43 PM   #3
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Re: Self Pay Price of Fentanyl vs ???

Woooooaaaahhh!
I'm literally about to put my pharmacy's phone number into my phone contacts so I can call about price straight from the doc's office right then and there. If 45 mg of methadone is only $30 a month without insurance that would save me $120! That's crazy! When I was at my appointment last month my doc was thumbing through a book/magazine type thing (looked kind of like a readers digest- I still have no idea exactly what that was) but he said the patch was most definitely the cheapest (he was also reading in this 'book' that Oxy IR only came in a 5 and 10mg pill- I have already bookmarked a few pages on my phone to show him otherwise- I guess at this point it is relevant to note that my GP handles my PM, obviously not his specialty so I can understand his ignorance on some of these things- AND, before anyone says it, myself and my doctor prefer this arrangement. He knows my money situation and is so good to me in that regard, even with the cost of office visits. He has even stated that when I go for Epidurals that I just let the doc there 'stabilize' me if need be and return back to him for maintained care (he has been treating me nearly 20 years now, I trust his decisions with regard to my health). If this is the case- and I know prices can vary drastically from place to place, pharmacy to pharmacy but that is a really significant difference! Thank you so much! I think I'm seriously going to pick his brain about methadone, I do understand it has a very strong affinity/ability to lock onto opiate receptors (also the reason it's used in maintenance programs) so it has to have some kind of 'legs' to it.

If you don't mind me asking, do you take 1 45mg pill, or is it taken throughout the day...or, well, just how you take it, personally speaking.

Thank you again so much, like I said I know things can vary a LOT but it seems like methadone is a very prescribed medicine and has been around forever, so I would think the sheer quantity/manufacture of it would drive the price down...I can't believe I never thought about this.

Also- sorry for all the many tangents I just went wild with...I saw that figure and almost jumped out of the chair...haha.

Thank you once more!!!

 
Old 09-01-2012, 11:04 PM   #4
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Re: Self Pay Price of Fentanyl vs ???

I just wanted to thank you once more-I just checked the conversion for myself- and of course you were correct, I believe a 40mg methadone dose would be equal to my fentanyl dose and I also did a quick online chat with a pharmacy rep at walgreens (they, believe it or not, have the best prices in town for me- even beat walmart...I paid $20 for a W Card RX/Walgreens brand product savings program an its already paid itself off ten times over in two months! ...but the pharmacy rep said 4x10mg rox brand methadone tablets would cost me $26 with my savings card!!! I hate to jump horses midstream and not give a medicine better than a month to try before I decide against it, but I am going to have to insist on a switch. Since then I've also read with regard to fentanyl vs methadone for pain relief and everyone seems to sing the praises of methadone for pain for just that, it's ability to bind so tenaciously to opiate receptors! This is such a total breakthrough...whatever it is my doc was reading must be insanely out of date...LOL.

I can't thank you enough, this changes everything (or will soon!!) Thank you!!!

 
Old 09-02-2012, 08:22 PM   #5
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Re: Self Pay Price of Fentanyl vs ???

You are more than welcome!! I am always so happy when I can help someone out!! It has made my day as much as it has made yours! Lol! Yes, I use the Walgreens card too!! It pays for itself with the first script I purchase each year usually!
But anyway, I take the 1 1/2 of the 10 mg pills every 8 hours. It has a long half life, but for pain purposes still needs to be taken that often. It's weird like that. It stays in your body forever but stops relieving pain way before its half-life. I also take oxycodone ir 5 mg 100 in a month, for breakthrough pain and that is about $35-40. So even adding that you are still saving money.
Well now hopefully your doctor will prescribe that for you! But it sounds like he will so that's great!! Keep me updated!!

 
Old 09-10-2012, 10:24 AM   #6
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Re: Self Pay Price of Fentanyl vs ???

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Originally Posted by Whynowthis View Post
You are more than welcome!! I am always so happy when I can help someone out!! It has made my day as much as it has made yours! Lol! Yes, I use the Walgreens card too!! It pays for itself with the first script I purchase each year usually!
But anyway, I take the 1 1/2 of the 10 mg pills every 8 hours. It has a long half life, but for pain purposes still needs to be taken that often. It's weird like that. It stays in your body forever but stops relieving pain way before its half-life. I also take oxycodone ir 5 mg 100 in a month, for breakthrough pain and that is about $35-40. So even adding that you are still saving money.
Well now hopefully your doctor will prescribe that for you! But it sounds like he will so that's great!! Keep me updated!!
Hey, just got back from the doc and talked with him about switching over to methadone- and after realizing the price difference he didnt take into account at my last appointment he wrote me up for 10mg x2/day. Cost me $15! I took my first one about an hour ago and I already feel better! Thank you again- you saved me a TON of money!!

 
Old 09-10-2012, 07:45 PM   #7
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Re: Self Pay Price of Fentanyl vs ???

I hope you do well on the methadone. Did your doctor give you instructions on how long after taking off the patch to start the methadone? Its the best med for me for my pain, minimizing dose, and the least side effects. Oddly enough it was my first long acting med, and cost isn't a concern for me (I have good prescription coverage). Some people can do really well on it. I believe the most common reason it doesn't agree with folks is it can be sedating, especially in the beginning, and sometimes it sneaks up on you (one moment you are fine, and then you get the "nods").

It has a bad rap due to it being used and abused for addiction, but it can be great for chronic pain for some folks. Just be very careful to follow doctor instructions on the dose and what meds you can take with it (especially benzos, sleeping pills, and similar). I've found I need to take it four times a day. Talk to your doctor if you find a twice a day schedule leaves you in more pain at the end of the dose. I believe three times a day is most common. Best wishes.
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Old 09-11-2012, 07:49 AM   #8
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Re: Self Pay Price of Fentanyl vs ???

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I hope you do well on the methadone. Did your doctor give you instructions on how long after taking off the patch to start the methadone? Its the best med for me for my pain, minimizing dose, and the least side effects. Oddly enough it was my first long acting med, and cost isn't a concern for me (I have good prescription coverage). Some people can do really well on it. I believe the most common reason it doesn't agree with folks is it can be sedating, especially in the beginning, and sometimes it sneaks up on you (one moment you are fine, and then you get the "nods").

It has a bad rap due to it being used and abused for addiction, but it can be great for chronic pain for some folks. Just be very careful to follow doctor instructions on the dose and what meds you can take with it (especially benzos, sleeping pills, and similar). I've found I need to take it four times a day. Talk to your doctor if you find a twice a day schedule leaves you in more pain at the end of the dose. I believe three times a day is most common. Best wishes.
Well, I guess fortunately for me (even though I suffered through the past weekend), I ran short of patches because of my lack of knowledge of...how best to keep them on I suppose. I was using the Waston gel generic and the first one- a little corner lifted off my skin in the shower and dried out on me...so that only lasted a day...then one night at work I got so hot I got nauseous and lightheaded and had read enough about the patch at that point to know what was happening and ripped the patch off immediately...that's patch number two lost. The third one I had to remove early peeled off in my sleep...I didn't worry much at the time- I discovered Tegaderm shortly after those incidents but when I called my doc to explain how I 'lost' (could there possibly be a worse way to articulate that to your pain doc? LOL) three and was obviously going to come up short I found out that since it was the first month I had taken them that he could not prescribe anymore than ten for the month...so I worked through the past weekend in the midst of fentanyl withdrawal. I wouldn't wish that kind of pain on my worst of enemies...but in the end it worked out because when I got the methadone the patch was long since out of my system and about half an hour after taking my first 10mg tab yesterday I felt like I new man. Yesterday, and still now, I am nearly totally pain free. I can hardly believe it. This stuff is a wonder for me- and its SO cheap! I do agree it gets a bad rap with pharmacists and people that know you take it because it is so closely associated with maintenance of opiate withdrawal, but let the naysayers say what they will..this works wonders for me! I don't even feel lethargic at all, literally not at all. I almost feel like I have more energy just because I'm in almost no pain whatsoever. My need for BT meds is nearly non-existent! Again this is only day two and I will see my doctor in another 30 days to see how I'm doing by then, I may need to switch to a 3/day schedule. I understand the titration of methadone is low and slow to begin with until you're stabilized at a comfortable/agreeable dose.

Thank you all again for the well wishes and concern, it makes me feel so much better to know that people out there reading my posts have honest concern and interest in my well being...it really means a lot.

Thanks again,
Dave

 
Old 09-11-2012, 02:08 PM   #9
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Re: Self Pay Price of Fentanyl vs ???

I am so glad your doctor prescribed it for you! Yes, keep an eye on it to see if you need to go to a 3x a day dosing. That works best for me, and if I'm even an hour late I can tell! And it does make me very tired, but I'm on disability so luckily it's not a huge concern for me, but I can see how it would be for others. But it does work the best for me I think. At one point I thought it wasn't working as well as I wanted and talked to my dr about switching. He put me on long acting morphine, and boy did I suffer that month!! It made me realize how well the methadone truly works, and I have a new appreciation for it!

And because of its bad rap, I don't tell anyone unless it's on a need to know basis.

I'm so glad you are getting the relief you deserve! Let us know if you have any further questions!

 
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Old 09-25-2012, 07:39 AM   #10
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Re: Self Pay Price of Fentanyl vs ???

Well, after being on the methadone for a bit, how are you doing?? Do you find it is taking care of your pain? Are you having any side effects?? Are you sleepy from it? I know it really makes me tired, but I don't care because it works for me.
Anyway, was just curious as to how this worked out for you!!

 
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Old 09-25-2012, 08:33 AM   #11
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Smile Re: Self Pay Price of Fentanyl vs ???

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Originally Posted by Whynowthis View Post
Well, after being on the methadone for a bit, how are you doing?? Do you find it is taking care of your pain? Are you having any side effects?? Are you sleepy from it? I know it really makes me tired, but I don't care because it works for me.
Anyway, was just curious as to how this worked out for you!!
First, just wanted to say thank you for your concern- means a lot! so after about two weeks...I LOVE it! My pain is at a steady 4-5 around the clock and when I have a bad moment the Oxy IR I have for BT knocks it right now.

This is a miracle drug as far as I am concerned. I do feel like I may do better on a 3x/day dosing schedule though. I work in a kitchen and my pain/hunt for the right meds/dosages would be over if I had that one more tablet for after work when I am most sore. At the moment, I take one when I wake up and one before I leave for work usually around 4-5 to get me through the night.

As for sleepiness or the 'nods' I haven't had any issues at all! I am finally SO happy with a medicine.

I see my doctor again in about two weeks...I'm not sure whether its more prudent to add one more methadone dose per day for my pain late at night related to work ( I usually work 4-11ish) or stay at two per day and add one more Oxy to have after work (though I feel this really wouldn't even touch the pain- and I DO NOT want to go down the self medicating road..which I know is so easy with those little Roxi). That really is my only complaint. It almost seems like a waste to take another LA med at 10:30-11PM...then again I may not need it if I took a noon time methadone...of course it's all in my notes to speak with my doctor about. I almost wonder if an IR med for BT pain that has some long(er) acting qualities may work more to my benefit for work times. Say, if I was allotted one 10mg Opana IR for before/after work or even dilaudid- which I assume is much less expensive- (both of which, to my knowledge, have a tendency gel up a bit to hang around in the intestines for a while, giving them both a very mild LA quality- even in IR formulations). -I mean to say, like 30 10mg opana IR per month to allot for the one per night in addition to the methadone twice a day and my Oxy for BT. So much left to still speak with my doctor about but I feel like I'm soooo close to a mix of drugs at the proper dose that I can be stabilized for some time now!

Thanks again, take care and hope you're doing well!

 
Old 09-25-2012, 08:02 PM   #12
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Re: Self Pay Price of Fentanyl vs ???

Definitely just explain to your doctor how you are doing and leave the meds/doses up to them. However, having the most even dose of Methadone in your system is likely the best scenario...if you are like most people in that a methadone does doesn't last 12 hours, then taking it evenly every 8 hours is probably a good non-complicated start, whether that means splitting your daily amount into 3 doses, giving you 50% more a day to take a third dose, or something else.

From my personal experience, I have a lot more pain at work and had assumed that taking a higher dose before/during work or spacing my doses to give me the most coverage at work would be the best, but oddly enough, equally split doses keep me at that constant level best. Otherwise, my levels would drop so low at other times that even that higher dose going into work wouldn't bump me up enough. Glad to hear you are doing well. I too have methadone as by far the best med for me. Best wishes.
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