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med and insurance issues again!

The wonderful PA at my PM clinic has been trying her best to help me.  I changed from MS Contin to Oxycontin due to tolerance issues but the Oxy worked so well for me I wanted to stay on it.  

So I feel like the Oxycontin works faster and is more consistent with its pain relief.  

Only problem is the cost.  Oxycontin costs $575.00 while the MS Contin is only $50.00. 

I have been on it for 7 months and am now in the doughnut hole and cannot afford the $240.00 it would cost me now instead of the $37. 00 it cost before the doughnut hole.

I can make the MS Contin work fine as long as I have bt meds so not a huge problem but talking to the PA this morning, she says Oxycontin will not be available much longer because it does not have as much abuse deterrent as the Xtampza does.  So the government agencies are going to insist we use the Xtampza which has at least a 20 year patent and is $400-$500 as well.  

She gave me a script for oxycodone Er which I did not even know was available but again $550.00 so I was forced to go with the MS Contin.

I am just upset that all our choices are being taken away just because some idiots choose to abuse them.  It is so unfair.  

I forgot to mention we also looked at hysingla just to see if it was a possibility and again way too expensive.  

Of course I can get what I want for 6 months til I hit the doughnut hole but not sure that's worth it.  What if in month 8 I needed some super expensive antibiotic or something?  And that would be my luck!

Some days I just feel like I can't win.

Cindy


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Comments

  • Nutcase007,  Thank you so much for the suggestion.  If I was not already on a short acting med that might just work.

    At the PM I go to they want most everybody on a long acting and a short acting med.  But if things keep going the way they are now with our choices for long acting being few and far between, they may have to change things.

    I am just trying to go with the flow for now and make my present option work for me.

    After she told me about the government wanting to completely do away with Oxycontin, it just makes you wonder what's next.  Thanks again.

    Cindy

  • Try the generic oxymorphone hcl ER by Global Pharaceuticals.....its cheap and works great for me.


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  • Sandi123,  How cheap is it to purchase without insurance?  It is not listed on the formulary I have.

    Cindy

  • L4_L5LL4_L5 Posts: 1,128
    edited 05/29/2018 - 7:43 PM

    GoodRx has it listed at $47 monthly (without insurance). 

    That’s for @sandi123 ‘s stated dose in this thread:

    https://forum.veritashealth.com/discussion/comment/460570/#Comment_460570

    I don’t know how you’re going to ask for it, though, as most doctors frown on patients requesting or name-dropping specific medications.

    Proceed with caution  :o o:)

  • Sorry I didn't see the question regarding pricing until now. I believe about 40-50  dollars is about right without insurance.

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  • Somehow I got switched from Oxycodone with Tylenol with a $7 copay to Morphine Sulfate IR for $75 that did not work. Earlier I was on OxyContin 5mg to supplement my Oxycodone and it never made a difference in my pain control, that one had a steep copay as well.

    It really makes me wonder if these pain management specialists know what they are doing. I have for the most part been on generics with a lesser copay and they have worked pretty well.

  • L4_L5 & Sandi123,  Thank you both for the info on the Oxymorphone ER.  I am going to see how much it says price without insurance is online and if affordable I will ask her at next months appointment.

    I have been with this clinic for almost 8 years and can ask her for anything.  This month she gave me the Oxycontin script, Oxycodone Er and said to fill whichever one I could afford and said to ask about Hysingla and come back for that script if I needed it.  I ended up going back for the MS CONTIN script and asked her instead of 60-30mg, to please give me 30 - 30mg and 60 - 15mg so that if I have vomiting issues I am not just without any Long acting med for the day.  She had no problem with it.

    So thanks to you both for the idea and I will let you know if it works out.

    Cindy

  • Just curious... what is a “donut hole”? Is that your deductible or? 

  • Medicare Part D insurance is your prescription drug coverage.  When what the insurance pays and what you pay out of pocket reaches $3750 for the year, you will at that point pay, no more than 44% for generic drugs or 35% for brand name drugs instead of my usual, $5, $12, or $37 depending on the type of drug it is.

    After your total of what the insurance pays and what you pay out of pocket reaches $5000, you pay the greater of 5% coinsurance or $3.35 copay for generic and $8.35 copay for all other drugs. 

    This all resets and starts over January 1st of each year.

    So you can see how quickly taking Oxycontin charging the insurance $575 got me into this doughnut hole.  Just about 6 months and then at that point I would have to pay 44% of the Oxycontin plus every other drug I take until January rolls back around.  And God forbid I would need some expensive antibiotic or something it would cost me the 44%.

    I hope this explanation makes sense.  If I screwed it up, someone please let me know.

    Cindy


  • N2..I would suggest next open season you review your options for a secondary insurance plan. Compare cost of part D and what it cost for it. Take consideration the coverage of your medications cost ect and which way would be more cost efficate for you in the long run.

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