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Old 02-10-2013, 06:52 PM   #1
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Unhappy Help with extended release meds

I started on nuycenta , then opana er, now exalgo at a cost of over $600.00 a month. I can't keep paying this price to try what might help me. I have not had any luck with the ones listed above. Is anyone on a extended release that is cheaper and actually works for them.

 
Old 02-10-2013, 08:19 PM   #2
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Re: Help with extended release meds

What else have you tried? Fentanyl patches, MS Contin or Kadian (morphine), or methadone should be cheaper than those, and they are all generic. I'd discuss the cost issue with your doctor. Instead of asking for a specific med, you may want to bring in a list which would be affordable to you, such as from your insurance. Or, just say you need something generic. Best wishes.
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Old 02-10-2013, 08:49 PM   #3
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Re: Help with extended release meds

Quote:
Originally Posted by kmundy View Post
I started on nuycenta , then opana er, now exalgo at a cost of over $600.00 a month. I can't keep paying this price to try what might help me. I have not had any luck with the ones listed above. Is anyone on a extended release that is cheaper and actually works for them.
These are all the new meds and most expensive. There are many generic less expensive meds.

 
Old 02-27-2013, 04:46 PM   #4
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Re: Help with extended release meds

I took my doctor my bill from the pharmacy. $533.79. He seemed to be sympathetic towards me and I also explained I was having to take my break through meds and was still suffering especially at night. He is suppose to talk to thr drug rep and increase the dose if I can get it affordable or switch me to something else��

 
Old 02-27-2013, 04:47 PM   #5
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Smile Re: Help with extended release meds

I took my doctor my bill from the pharmacy. $533.79. He seemed to be sympathetic towards me and I also explained I was having to take my break through meds and was still suffering especially at night. He is suppose to talk to thr drug rep and increase the dose if I can get it affordable or switch me to something else😊

 
Old 02-27-2013, 06:56 PM   #6
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Re: Help with extended release meds

I don't see how talking to the drug rep could make it more affordable? Only way is if you are low income and they can sign you up for a free med program, but those can be tough to get into and take some time.

The med price won't go down for a long time (until it goes generic when its 10 year patent expires), and your dose will only increase over time, so it will be more expensive. I've heard of people taking such a high Exalgo dose that the monthly cash cost would be $4k!

There are definitely generic/affordable options, so you need to push your doctor a bit that this just isn't an option for you to stay on it. So do you pay cash for meds? Best wishes.
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Old 02-28-2013, 03:11 PM   #7
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Re: Help with extended release meds

The drug reps have these prescription cards for every name brand expensive medication you can imagine to help push them and they lower the co-pay. I don't know if they help with out-right pay though.

I was taking Nucynta and I can tell you right now it is a real medication (quite capable) but I needed extreme doses of the instant release (over 600mg a day) and even though the Dr wrote me a script to take up to 8 of them a day the insurance company said no way and only did a partial fill. My insurance company will automatically do that on any medication if the Dr fills more than the medication company has said is safe. Which for nucynta I believe is 600mg.

He ended up giving me 200mg ER 2x a day and while you may not notice they are working I can assure you at that dosage they are doing something. Because sure enough without them my pain is much worse. He did oxycodone as the break through even though he was trying to get me to do nucynta for break through and I told him I will NOT do 2x name brands a month and has always accepted that. I have stood bye that for a very long time... it is obvious he is super budy budy with all the drug reps because he has the prescription cards for every name brand he has ever prescribed: embeda, fentora (I think), and a few others... I had (past tense) been seeing him for 2-3 years and insurance just stopped covering him. May have to go back as cash patient because the PMP they do cover just told me we only do procedures and had the balls to tell me that what he recommends is getting a second neurosimulator lead or an adjustment when I already told him the insurance company won't cover it and the adjustments have been done like 10 times.

Also they like this drug and all the other new ones because "they are less likely to be abused" embeda actually has tiny little capsules with a special drug that will counter act the hi if you break the pill apart or something like that.

So they like thinking they are doing the right thing and keeping drugs off the street which I understand...

But if I had NO insurance at all... I would be taking methadone for the all day and the break through. Which he had no problem prescribing me the 3 months I had no insurance when I lost a job.

That stuff is dirt cheap and you will see a lot of people are happy with it. Just be careful because it is a poorly understood medicine by Dr's, pharmacists and everyone and it carries a stigma that you are some sort of addict if you take it just because they use it to keep real addicts from getting high off of morphine.

But really that is the cheapest thing you can buy and was actually recommended to me by the Pharmacist who actually cared when I asked him what I could afford because $400 a month for morphine and oxycodone was too much for me. If they told me $600 I would cry... and I actually did almost start crying once when they told me the price for embeda off insurance. Took it right back to the Dr!

I know some Dr's are not like that and won't work with you and some just absolutely treat you like an addict I actually had a nurse in a hospital tell me the Physician thought I was an addict and that was why I was there when I had a severe reaction to an IV antibiotic PIC LINE in my arm and all (felt like a heart attack and cause rash and slew of other issues).

Hopefully he will work with you on it... it is hard enough just finding a Dr that will prescribe anything real and just as hard getting the Pharmacy to order it (if it is a name brand).

I really do hope you can talk some sense into him. I told the PMP that I did a consult with that was covered by my insurance that I was coming to him because I didn't want to pay $150/m to see the other Dr and he was like that's nothing... yeh that's nothing when after all your expenses you are trying to decide wether or not to keep cable.

So I couldn't imagine $600 a month plus whatever your breakthrough costs.

 
Old 02-28-2013, 03:42 PM   #8
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Re: Help with extended release meds

Interestingly I thought I had already responded to this but it is gone...

The drug reps have these cards that you give to the pharmacy that lower your prescription costs or co-pays. I am certain that Nucynta has one (I have one) but I am unsure if these help with cash only customers. Sometimes (embeda) those cards are good for as long as 13 months. I also think some of them even re-up if they change the dose.

Any doc that pushes name brands on people should have these on hand. Sometimes they expire and get changed though and the rep might be the reason they are not on hand. They could also be limited BUT I DOUBT IT.

Nucynta is the new "less likely to be abused" drug that Dr's love even my primary dr knows about it which is rare and the insurance company even has a special reduced non generic co-pay because they love it too (only the ER not the IR).

I can tell you that the stuff really works on high doses and is a quite capable medication... I originally was on 600/day of the IR but needs about 8 and the Dr was cool with that but the insurance company was NOT and did a partial refill. The reason for the partial is the insurance company has stopped several scripts from this Dr where he prescribed more than what the company recommended. Which I think in this case is a max of 600/mg I think I read because they just don't know if it is safe because they have not tested that high of doses in trials.

That said when I was without insurance my Dr had no problem prescribing me methadone for both the IR and ER meds and it worked great... it also works on one more and one different receptor than most opiates if I remember correctly which is why some Dr's prescribe it with a different drug to get 3 (i think) receptors. My Dr however was not with that trend and refused to prescribe anything but Methadone along with the Methadone.

It really is dirt cheap though.

 
Old 05-03-2013, 10:41 AM   #9
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Re: Help with extended release meds

I am speaking without MD type education, but from experience I can tell you that Methadone is an inexpensive powerful pain medication. I have been on it for about 2 years and take 9 x 10mg a day without any problems.

God bless you
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Old 05-04-2013, 01:48 AM   #10
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Re: Help with extended release meds

So far MS Contin has been the best LA drug for me.

I get the generic and it is very inexpensive.

Tried the Kadian, Avinza, and Nucynta and truthfully I didn't even pay any attention to what the cost was.

Insurance paid all but 20.00 on each.

Nucynta didn't seem to cover my pain much at all and when I took the Avinza I had some weird reaction.

My Doctor thought it might be due to some filler that was used in it because of course I can take the MS Contin fine.

It's been so long ago that I tried the Kadian, I can't really remember why I didn't continue with it.

Anyway, the MS Contin covers my pain well and lasts me the full 12 hours it is supposed to.

So far I am really happy with it.

Hope you can find what works for you that is affordable.

I know how that goes, our insurance covers meds well, but we have lots of medical debt for other out of pocket expenses.

Take care.

 
Old 05-04-2013, 06:02 AM   #11
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Re: Help with extended release meds

I agree that methadone is very inexpensive. I was surprised when the pharmacist said it was not covered by my insurance, but then quoted a very low cash price. I am still confused as to whether it is considered long acting or not.

 
Old 05-05-2013, 03:46 AM   #12
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Re: Help with extended release meds

Methadone is not really long acting as far as how long you can go between doses, It is long acting by virtue of its half life and when you start out it takes 5 days to reaches steady serum level in your blood. Basically on day 5 you have almost twice the amount in your system as you would from taking a single dose. If you take a 100 mgs a day for 5 days you have so much left in your system on day 5 the you would have to take 200 mgs n a single dose to reach the same serum level. This is why its crucial to grin a d bear it the first 5 day and not alter your own dose because it's not effective on day one. It will be twice as effective on day 5.

Some docs are confused as far as it being long acting due to its use as to prevent withdrawal.Particularly those not in the field of PM like ones GP thinking they are qualified to prescribe meth, Once a day dosing is enough to prevent the onset of withdrawal when using meth maint as a substitute for opiate use/abuse. But as far as how often you need to take it, I used it for almost 3 years before my pump was implanted and I took 120 mgs a day in 4 divided doses taken the same time every day. My pain would get out of control, if I went beyond 6 hours between doses. So it does last a little longer than normal short acting where your lucky to get 4 full hours of relief, For the best results I had to to divide the doses into more manageable 30mg doses taken every 6 hours through out the day. My doc prescribed it initially 3 times a day but we talked and he was fine with altering the dosing schedule as we weren't altering the daily dose schedule which is what matters when your trying to achieve steady state plasma levels.. I have seen some docs leave their patients miserable with 12 hour dosing which is crazy since most of have to use the generic 10mg pills. All the studies on using it for acute pain use 4-6 hour dosing even though you still have some of the dose from 5 days prior in your system. But to answer your question it's not a LA med, Just a med that has an extremely long half life, 30+ hours. Similar to Valium with a exceptionally long half life beyond 24 hours. They don't dose that once a day because it's not effective for the same reasons.
I am not a doc either,it was just my only choice due to disability back when SSD and medicare didn't have a Part D and I was on my own as a cash customer for all prescriptions. Good luck, Dave

 
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