HealingWell
Search Close Search
☰

actiq-fentora-onsois...nosey question

Support Forums
>
Chronic Pain
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/13/2010 7:38 PM (GMT 0)
the only reason I had to stop taking the Actiq was that insurance would no longer pay. Does anyone have an insurance that WILL cover it for anything other than breakthrough cancer pain?
thanks
catahoula
Posted 7/13/2010 7:51 PM (GMT 0)
What is the other name  for actiq? I don't think we have that in Canada. I've never heard of it. What does it compare to? Is it a narcotic/opiod?
Posted 7/13/2010 8:35 PM (GMT 0)
Actiq is fentynal mixed with sugar( I'm sure there are other ingrediant but don't have the literature in front of me at the moment) and formed into an @ 1inch lollipop you place in your mouth up against your cheek. It took @ 5 minutes to dissolve but there was almost immediate pain relief. It was the one medication i used that was able to almost totally eliminate my pain and allow me to function as near to normal as possible. Insurance used to pay for it up until @ 2 years ago. When I tried to self pay it was costing me $2700.00 a month which totally wiped out savings and retirement funds and left me with a visa bill whiich I have managed to get down to $11,000.00 Seems as though I will never get it paid off. Obviously I just can't afford it on my own. Unfortunately I have found nothing else that offered that kind of relief. There is a generic version by Anesta which brought the cost down some but still not enough to warrent self pay...too bad. I swear if I ever win the lottery, Actiq will be the first purchase I make. ;o(
catahoula
Posted 7/13/2010 8:50 PM (GMT 0)
Hi -

Suzane - Actiq is oral fentanyl citrate. Same medication (Fentanyl) used in the duragesic patches.... just taken orally, on a stick as a "sucker". It was originally prescribed as a medication for breakthrough cancer pain, but it's also prescribed "off-label" for chronic breakthrough pain. There's many different strengths of Actiq - 200mcgs, 400mcgs - up to 1600mcgs. Fentora is the same medication, but it's a not a sucker - it's a quick dissolving tablet you place in your mouth. And, as Frances shared, it sounds like Onsolis is the new thing (an oral tablet like Fentora) but w/ less sugar, from what I understand...

Catahoula - My insurance does cover it... but it's pretty hard to get this medication covered. First, to even be prescribed it - you have to be an "opioid tolerant patient" - which means (I'm copying this from the Actiq site) : Patients considered opioid tolerant are those who are taking around-the-clock medicine consisting of at least 60 mg of oral morphine daily, at least 25 mcg of transdermal fentanyl/hour, at least 30 mg of oral oxycodone daily, at least 8 mg oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer.

I have Aetna insurance - and for as many health issues as I have/medications that I need, and so forth - it's been awesome for us. I do know when we had Kaiser for a short time, years ago, Actiq/Fentora is NOT on Kaiser's "formulary" - and, thus, we had to pay out of pocket for it. I did these a few times - but I had to go off of it for a bit. It was costing about $1800 per month. It's ridiculously expensive.

We had HealthNet way back when I was 1st prescribed the medication... and it did take awhile to get it covered. I think what helped is that I had exhausted every medication, at every varying doses, etc. I was spending tons of time hospitalized and so forth. I think the insurance finally came to the conclusion that it was cheaper to prescribe this medication. It's all a money thing, you know. It also helped that I had a doctor that was truly advocating that I needed this medication for a higher quality of life.

Just curious - so your insurance company WAS paying for it? And then quit? What was the reason? Is there any chance they'll cover it at a lower dose/lower quantity?

I've read that 90% of people using this medication are using it "off-label" (non-cancerous breakthrough pain) so there ARE companies paying for it - because it's hard for me to imagine many people can afford this medication sans insurance. It's just a pain to get it covered... I'm assuming that it was helping you? Have you tried to see if they'll, perhaps, cover the Fentora? Just a thought....

--Tina
Posted 7/13/2010 8:51 PM (GMT 0)
Sorry for the repeated info :) I was typing, Catahoula, I guess as you were posting :)

--Tina
Posted 7/13/2010 8:53 PM (GMT 0)
Got it - now I understand your situation. Yeah, it was $1800 for me per month - and that's when I was down to 1 per day (I was previously using it 3x a day, at my worst).

I'm so sorry - it sucks when there IS something that helps - and you can't get it. I understand completely.
Posted 7/13/2010 9:34 PM (GMT 0)
Catahoula,

I have Blue Cross/Blue Shield and normally....ANY generic is $10.00 for 30 days. That has been for some pretty costly ones, also! I went to my web site and tried to check fentanyl citrate and it came up, but would not give me any pricing info...in the price column it said "pre-approval required" so I can not tell if they would honor the "generic pricing" or not! I am considered opioid tolerant, based on the info Tina posted...I take 60mg ER Morphine 3 times a day. I just wish I could find something that gave me a life again, and I know part of it is needing to get on meds for RA.....but the lower back pain, that has been around for 3 years is out of control!!

My PM doc had given me....what I considered to be a wonder drug...Levorphanol! I took it and felt soooo much better! I had been feeling really good.... but felt like I may need to bump from the 2mg to the 4mg soon....when all of a sudden I could not get them! The manufacturer could not supply the demand and they went on back order in February. They were supposed to be B/O'd until late March......weeeelllllll.....now it is supposed to finally be available in late July! February through June were very tough trying to find something that worked okay and get to a good dosage.....but I still do not feel like I felt on the Levorphanol! I would soooooo like to be back on them, but what happens IF the come back and then can't keep up again! Sorry.....I just made a short story long and was just trying to say, I can really relate to not being able to get what really helps you!!

Take care,
Beckey
Posted 7/13/2010 11:58 PM (GMT 0)
My UHC insurance covers the generic for a very nominal co-pay as long as it is written by either a board-certified pain management specialist or an oncologist. My PM has to submit lengthy paperwork for them at least once a year, sometimes as often as once per quarter.

Many insurance companies do not cover it except for it's FDA-approved on-label use.
Posted 7/15/2010 12:35 AM (GMT 0)
Have you tried the Fentanyl patches?  That's what I take.  I'm on Medicaid and they even pay for the patches.  Just a suggestion.    I hope you can find something that helps or get the Aqtiq back.  Good luck and take care.

 

love and hugs

Loretta

Posted 7/15/2010 1:46 AM (GMT 0)
Yes, my insurance tried to pull that nonsense a couple of times but my doctor sent them a medical necessity letter and a letter that states it is for irretractable pain and it exceeds the recommeded dosage of 4 a day. I have been on it for a long time. My only problem with the Actiq is that it has sosoososososos much sugar and has destroyed my teeth. My beautiful teeth are ruined from this medicine. It helps me but I ask at what cost???Insurance companies need to stop telling doctors how to run their practices and stick to being an insurance company that pays insurance bills......Fight. The do not have the right to tell your doctor what he can and can not give you for our condition. I heard this was going on from other people at the pain management center but everybody is fighting it.
Posted 7/19/2010 9:10 PM (GMT 0)
Onsolis is the new fentanyl med and it is basically a film that you put in the cheek like Actiq and Fentora. It dissolves in basically the same amount of time. Onsolis is only approved for cancer pain as is Actiq and Fentora, but it is under the FDA new REM program, which from what I've heard, all BT fentanyl meds are headed. A doc has to get special accredidation to prescribe Onsolis as does the pharmacy where you would get it filled. It's a crap load of red tape and paper work. My doc talked with me about it and asked if I wanted to try it but after going through the hoops to get it for another patient he said if the other fentanyl bt meds were working, not to bother.

 

✚ New Topic ✚ Reply