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Insurance will no longer pay for oxycontin

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Posted 8/4/2013 5:42 AM (GMT 0)
Hi all, new here. Much Chronic pain, I have SLE, Sjogren's, osteoarthritis, Fibro, neck and back pain and recently broke and dislocated my tailbone:-( Was taking oxycontin 30 mg three times a day with oxy 10/325 as needed for breakthrough. Insurance has decided that they will no longer cover my oxycontin. My Dr. and I have filed an appeal but that will take up to a week to resolve. I can't afford the oxycontin out of pocket, ~ 700 a month as I am currently unable to work. Dr. wants me to try Morphine ER @ 60 mgs twice a day and having the oxy 10/325's for breakthrough. Anyone who has made the switch, I would welcome any opinions, experiences with the change. So tired of insurance co's telling Dr.s how to do their jobs! Thanks in advance Kelly
Posted 8/4/2013 8:03 AM (GMT 0)
Hi Kelly and welcome to HW.
Many folks have had this issue since the availability of generic oxy became non-existant. Insurance companies refuse to play well with the drug company's money making games leaving us the patients to do without food for our meds or find something else that works.

As for MS, lots of folks here on it successfully and its a good second choice along with your oxy for b/t. The tricks going to be getting the correct amount of morphine to cover the oxy. This is where the good Drs definitely shine through. Pain specialist generally do better with converting then a PCP or general practioners.

Give it a fair chance to take over and discuss with your Dr if the dose isn't covering at least the same amount of pain the oxy was and hope its even more.

Good luck
Posted 8/4/2013 8:04 AM (GMT 0)
Hi Kelly! Welcome to HW/CP - but of course sorry that you had a reason to find us. We have members here who have had very good luck with Morphine ER and I'm sure they will be around soon enough (might be a few more hours because of the time though!). Unfortunately I am not one of them - Morphine (both ER and IR) offers very little pain relief for me. It's just one of those things - certain meds can work very differently with different people.

It really stinks that your insurance is no longer covering the Oxycontin - it's becoming more and more common, unfortunately. The sad part is that in many instances it's not because of the cost - it's because it is the 'dreaded' Oxycontin, the evil 'hillbilly heroin'. Because those same insurance companies pay for many non-narcotic medications that are MUCH more expensive. They don't care that Oxycontin has literally given many people their lives back, allowing them to work, play with their kids, fix a meal, etc. Ok, better get off my soap-box now!

Others will be around soon. Have a peaceful day!

Post Edited (Splashdancer) : 8/4/2013 2:09:08 AM (GMT-6)

Posted 8/4/2013 3:52 PM (GMT 0)
Hi welcome to HW!!!

I am very new here to so I dont have any good advice but I am also just starting the Ms Contin and Im on 15mg twice daily waiting for dosage fit.

I have never taken oxycotin but its related to oxy and thats what I myself am trying to avoid, although for others its a perfect fit. I have not had any bad side effects with the morphine and am finding it to be great but Im thinking I may needed a bit higher dosage.

Thats hard to hear that your insurance company can just suddenly choose not to pay for a medicine. I hope the morphine works for you and please if you could update us and let us know how it works and how you got to the right dosage.
Posted 8/4/2013 4:21 PM (GMT 0)
I haven't seen that you've posted any further comments, beyond this one, so I'm not sure you're checking in on our forum often.

I'll keep it brief. (The Mods will be in shock).

I am not providing any links, nor any company names, just the information. My PCP (the first time I was put on OxyContin), I could not afford it (it was, back then, way over $650/month). HE knew about this, and HE put me in touch with companies that assist people in getting this medication if they cannot afford it. It requires a lot of paper work and your physician is a huge part of this process, but if you are accepted, they will pay 100% of your prescriptions. Mine were for 3 months, and my "case" was reviewed every 3 months.

Many companies offer this service if you cannot afford your meds, not just this one. Many companies also offer coupons for many medications when price is an issue. Ask your doctor. You need legitimate prescriptions, your doctor's full support, justification you are "in need," qualify,...and your doctor/s are in every step of the way.
Posted 8/4/2013 9:57 PM (GMT 0)
Some people get really good relief with MS Contin, and some don't.

If you try the MS Contin and it doesn't work, and you move on to something else (Fentanyl, Opana, Nucynta, Exalgo) and those don't work either, then you'll have a much better chance of winning the appeal (IF they deny this first appeal).

A lot of times an insurance company wants to see you try a few other (usually cheaper) options that are applicable before they'll give you the approval for the more expensive med you want.

Luckily I tried a few other long acting medications before my doc put me on Oxycontin, because she was able to say I had tried the other meds unsuccessfully when she did my appeal.

I got denied coverage, then my doc appealed, the initial appeal got denied, and then my doc ended up doing a "peer review" with a doc from the insurance company and they agreed to coverage.

So don't give up even if this first appeal gets denied. You might have to try a few meds first, or get your doc to do a peer review, but if Oxycontin is the best medication for you, your doc can fight for it on your behalf.

But who knows, maybe you'll like one of those other meds better!
Posted 8/8/2013 12:48 PM (GMT 0)
I'm not exactly sure how the appeallate process works with medications but I would like to put in my 2 cents. I was taking the 80 mg OC for years and was switched over to the MS Contin as an experiment. I took the 100 mg for about 2 years and now I'm taking the 200 mg MS Contin. At 800 mgs a day, it's been working well for my pain but I also have the Oxy 30 mg to use for BT pain. My point here is this: If you're taking 30 mg OC and you switch over to the MS Contin, in my opinion, I think you would need at least twice the mgs of the MS Contin say maybe 60 mgs or even 100 mgs just to start. The difference is almost 2-1 in strength. It's not nearly as tough on pain as the OC is but it helps and that's why I say increase the dosage/strength. It may make you sleepy too, another side effect to the MS. Just my 2 cents.
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