| Re: Exalgo (hydromorphone)
I actually just talked to my pain management doctor today as I saw an ad for it in a Pain magazine. Exalgo is brand new and my PM's practice has only prescribed it for a few patients - those that have been intolerant to other long acting medications or for whom other drugs no longer work (the patient has a tolerance to those now and needs a new option). My PM said they won't consider it for me right now and they'd like to get more feedback from their patients and coordinated feedback from patients all over who are prescribed Exalgo (doctors report to the manufacturer what feedback they are getting).
It is very expensive and I verified that it does not yet have a co-pay assistance card. So I can't even consider it yet. I was on Opana ER for a while and that was about $60/mo with a co-pay reduction card. During a financial crisis that too was too expensive so I went back to MS Contin which has worked well and under my plan is $10/mo.
If you have just started pain management I would think they could try more well known medications (such as Opana ER, Kadian, MS Contin, etc) and these would also be less expensive. My suggestion would be to call the pharmacy and put a stop to the prescription right now, call the pain management practice and tell them that the cost to you is prohibitive at $250/mo, and ask for possible generic options or other name brand options that may not be generic but are known to work well. Personally I'd not pay $250 unless I knew I had no other options.
If Exalgo is found to work well I'd try it, but only if I had a co-pay assistance card or it was less expensive. My PM doc said they had one patient who only took it 2 days and had some adverse effects so they are only now prescribing it to those who have tried all the other more well known and well used options. Can you imagine paying $250 and finding it made you ill? If you do have a desire to try it see if you can get maybe 1 weeks worth first so you can pay less. If the cost is $250/mo, and it's 1 pill per day, that makes it over $8 per pill.
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Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08
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Have you let your new PM know how expensive the medication is going to be and that you're pharmacy doesn't even readily stock it? Maybe your PM would be willing to give an alternate medication. There are so many medications available for pain management and most come in generic so the co-pays aren't too bad at all. I would at least let your Doctor's office the issues your having just getting the medication filled and maybe there is another medication that can be prescribed that your pharmacy will keep stocked and will be less of an expense to you. 
