HealingWell
Search Close Search
☰

New to the forum & having issues with my medication

Support Forums
>
Chronic Pain
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 2/4/2015 10:52 AM (GMT 0)
I'm on subsys every 6 hr and also actiq. My problem is I can't go more than 4 hr on subsys without feeling like I'm going thru withdraw and the a actiq is only good for couple hr so what is the problem. Please help






I have added a heading to your post so more members will see it.

Post Edited By Moderator (straydog) : 2/4/2015 8:24:33 AM (GMT-7)

Posted 2/4/2015 2:37 PM (GMT 0)
I had subsys for 30 days because I had a 30 day 30 pill free coupon from my doc. my insurance wont cover it and the copay was 7000.00 I cant get it again. my pm nurse says they are working on getting it filled. that was sept. I quit waiting. now ins has replaced my oxyCONTIN with oxyCODONE because they can
Posted 2/4/2015 3:27 PM (GMT 0)
Hello Cheddar Man & welcome to the chronic pain forum. Glad that you found us but sorry you have to be here.

Perhaps if you could tell us a little more about yourself we can give you some ideas. Keep in mind none of us are drs here, we just speak from our own personal experiences.

Take care.
Posted 2/4/2015 10:43 PM (GMT 0)
Hi CM,
Welcome to HW. I was Rxed Fentora for about 4 years, it's another FentanylIR like subsys. These IRs are meant for temporary relief delivered fast, fast, fast. That is all they are for. They will never give you more than a very few, 0.5- 2.5, hours relief. . . Q
Posted 2/5/2015 12:09 AM (GMT 0)
pptrsha1, your dr has to agree to the change. Chances are the Oxycodone doesn't require Prior Authorization (PA) but the Oxycontin does. There is less paper work for the dr if the med doesn't require PA. Are you on Medicaid or do you have Medicare Part D ?
Posted 2/5/2015 12:24 AM (GMT 0)
Wpptrsha1,
I am in the same boat as you are. I'm on MEDICARE plan D and HUMANA is my drug coverage. They sent me a letter stating that I will receive 90 days of OxyContin and then I will have to revert to another covered drug such as Oxycodone UNLESS I get a prior authorization from my Dr. I brought a copy of the letter to my Cancer center and they are taking care of requesting the PA. It is all out of my hands now but since I have tried every analgesic in their formulary I am confident that I will receive my PA. it looks like you will need to contact your Dr. For a PA yourself. All these hurdles are in place to assure the continuing profitability of the Health Insurance market, go team . . . Q
Posted 2/5/2015 12:51 AM (GMT 0)
Medicare Part D Overutilization Monitoring System-
www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/HPMSmemo_MedicarePartDOverutilizationMonitoringSystem011714.pdf

Re:Patient Review and Restriction Programs as a Policy Option to Address Potentially Inappropriate Opioid Use in Medicare Part D-
http://www.pewtrusts.org/~/media/Assets/2015/Pew_MedPAC__Comments.pdf
Posted 2/5/2015 2:41 AM (GMT 0)
M&G,
Very interesting reading though one must search over utilization ( OU ) to reach the pertinent info. I had no idea that MEDICARE considers any non Cancer opiod use that exceeds 120 mgs per day of their stated morphine equivalence dose, MED, for more than 90 days to be "over utilization". That would put an awful lot of CPs in the crosshairs. While as a Cancer patient myself I am exempt, my CP wife, with an MED of 150 mgs, is in this OU category. We have never been notified by CMS or MEDICARE of this situation. I take it that this is only utilized when needed . . . Q
Posted 2/6/2015 3:27 PM (GMT 0)
I have medicare part d. my husband work for GM 35 years we had blue cross anthem all during his retirement (55yrs) and when he turned 63 and I became disabled they BOOTED us soooo fast!!
Posted 2/8/2015 6:24 PM (GMT 0)
I'm taking 120 mg of Morphine at present.2 30 mg MSContin and 4 15 mg Morphine IR a day.

I wonder if my PMD goes by that.I hope not.I hate to think that I've reached the ceiling of pain medicine that I can be prescribed.

Rick
Posted 2/8/2015 6:43 PM (GMT 0)
Hi Rick,
I sincerely doubt that you will be bumped as there are so many of us CPs that are "over utilizing" according to this rule. I use my wife, C, as an example . . . She has been Rxed various Opiods over a 15 year span, 7 of them under Medicare. Many of these scripts were over the limit and she has never received a notice about it. I think that it is one of those rulings that is only trotted out when needed or maybe it has been forgotten about. Did you follow M&G's link to the ruling? When I did it led me to a page that said I was in error, only when I plugged over utilization into that page's search function did I find the ruling . . . in other words, it was pretty deeply hidden amongst the bureaucratic minutae . . . Q

Post Edited (quincy17) : 2/8/2015 11:53:11 AM (GMT-7)

Posted 2/8/2015 7:29 PM (GMT 0)
rick don't go by my post I am new to medicare d value plan I didn't sign up for it the judge asked me if I had insurance at my ALJ hearing for disability I told him I have blue cross thru my husband and he wrote something down and when I got a letter from him he approved my disability back 2 years and I was immediately on medicare A & B &D so I obviously don't know the ins and outs yet. I also had fentora 600mcg 2 xs a day for 4 years and they took that away it was my life saver. so now I have to learn how to get around all the O.U. rules on every one of my meds. so far all it has taken is my doc telling them why I am on it and why I need so much. I will never be better and no surgery will help me. this is as good as it gets and all they can do is make me comfortable now.
Posted 2/8/2015 7:50 PM (GMT 0)
Hi Trisha,
I don't think that you should even bring up the OU issue as it is really off the board. I just re read the thing and it states that if your Dr. Says that your dosage amount is in the therapeutic range then all is well. No need in getting your Dr. all confused with a ruling that is ignored anyway,and he is doing it by the books in the first place. My wife and I went through the SSDI process without a lawyer and came out like a rose in spring or whenever those things bloom. Doing it that way sure taught us a lot about the ins and outs of the system and a major one is make sure you fill every form out promptly and also don't volunteer any info that they don't ask for. . . Q

PS: Make sure you keep all of the SSA benefit records so that you can use them for proof of income when applying for things like extra care, food stamps (SNAP), and LIHEAP. All of these programs can save you so much money, especially Extra Care which will pay all your plan A,B, and D premiums as well as get you out of the donut hole. This is only for low income folks, people that make less than around $27,000 a year as a couple . . . Q
✚ New Topic ✚ Reply