Alternatives to Morphine Sulfate

[alex44]

Hi All - Hoping everyone had a happy new year. I am having a BIG problem with the M........t Brand of generic MS-Contin. Simply put, It tears out my stomach due due to filler, confirmed that this is very likely according to my doc (an angel) who has other simaler complaints, strangely, it makes me need to use the bathroom a LOT more (Urination) and takes a LONG time to work. I have not had this problem with E...,R....., or P....r. Can anyone suggest an alternative? I have tried to get my local pharmacy to order it, no luck he has to take what he gets, even with advance notice, I won't be going there again anyway (see previous pharmacy threads, the Pharmacy at the clinic can,t/won'get it for me. I am afraid to try a 24 hour med as a ms-contin is supposed to last 12 hours, it doesen't, as I am sure most here know, What are my options? My IR is great - I would take those except I am afraid my insurance Co. would balk at at the number. Maybe a higher strengh would work - same dose, differant manufacurer if they have use one. I take close to 200mg. of the ER. Alternatives anyone? Help!

Thanks
Alex44
Skypilot

Happy new year

[Pharmacist.steve]

Both Avinza and Kadian are long acting Morphine.. but.. they are BRAND and insurance probably will not provide pay for them without prior authorization. I suspect that the pharmacies "can't" order the manufacturer that you want because the insurance company's reimbursement is less than the cost of the drug. Hard to stay in business if you pay $100 for some meds and the insurance pays you $90. It is a reality that pharmacies have to deal with ... with many insurance companies..

[alex44]

thank You P. Steve I am quite sure you are right - Esp after the last Snafu. I don't suppose there is a long acting Diludid in generic yet, I doubt they would pay for the new one, Exaglo(sp) I think, although I did see one post that said their insurance was going to cover it. One question, In the benifits manual, it says that if a patient cannot tolerate a particular generic, they have to give brand, which involves an overide by the doc. stating the reason. My doc (an angel) I am sure will do this for me but what are the chances this willl go thru - I have my doubts, am I supposed to suffer with a drug that I am grateful for but screws with my system? It is hurting my relationship of 20yrs badl due to me being in a bad state of mind due to pain. How would YOU deal with this if you were my pharmacist and asked to recommend something/ . and had a patient like me? I am only asking for your opinion as From the board I know you to be very up front and you are in the business of helping people.
Thank You
Alex44
Skypilot

[Leeaelle]

Have you tried OpanaER? That works great for me. I haven't read your other thread, but if these are spinal issues, if you use it also with Lyrica, it's REALLY good. Lyrica by itself doesn't seem to work well at all, but combined with Opana ER, it seems to be incredible! Don't ask me why, but there must be something about the combination. ????

I've been a spiney for 27 yrs, and this is the FIRST TIME I've had ANY level of comfort at all. And this is a real treat for me. Sure, I have flares at times, but I can stand that cause I know it will get better!

Best of luck, and I pray you find some relief for your pain. God bless and please let us know what happens. Hugs, Lee

[Pharmacist.steve]

@Alex... you never know if the insurance will pay until go thru the PA process.. and the process may have several levels of appeal ... and if there are several levels of appeals... I would bet that the first appeal will automatically be denied.. It is the easiest/cheapest way for them to discourage the patient from moving forward with the appeal and giving up.

[tortoisegirl]

I thought Kadian went to generic in Nov 2011? I read that at least Watson was making a generic for it.

Sounds like you need to get more detailed info on your insurance coverage.

Confirm that you will not have to pay the cost difference between generic and brand if your doctor says its medically required. They probably have to fill out a form or send a letter, in addition to signing the prescription as no substitution allowed. If they state that in their rules, and your doctor does the paperwork (plus you have documentation in your chart this is a continued issue), they shouldn't be able to deny it. Worst case it takes awhile for the paperwork to go through, and has to be renewed yearly (which may have a delay in getting your meds at that time).

Also check your cost for brand pain meds, and if there are stipulations before they are covered (such as a step program of trying one or more generics first, which may include short acting meds). Mine thankfully / surprisingly has no restrictions on quantity or brand/type of opiates. I only have to pay a higher copay (depending on if it is a preferred or non-preferred brand). I was even able to find this info online.

Check for both your formulary (list of meds they cover and your copay or percent cost), and any policy documents related to meds, such as a list of meds which require prior auth, a list of meds which require a step program, or a general policy on opiate pain meds (example: a insurance may say they won't pay for more than one long acting and one short acting med a month, and will only cover brand after trying two generics, which may include short acting meds).

If you can't find it online, call them. I did better with Google then their actually website; it didn't require any log on. For example, "Insurance X 2013 Formulary", without quotes. If you don't get someone helpful, try again. Best case you get a complete idea of all your med options, so you and your doctor can decide the best route (and possibly a back up option). Seems like your best options are brand name MS Contin, generic? or brand Kadian, or brand Avinza.

I believe Opana ER, Nucynta ER, Oxycontin, Exalgo, and Butrans patches are all still brand. So, if you tolerate morphine well, it would probably be smoother to just go to another morphine product, especially if you can get generic Kadian. Except if you've been on a morphine product for awhile and have built some tolerance, then you might as well switch the base med as long as you're doing a switch.

I know med changes can be scary...definitely ask to have frequent appointments during that time. My doctor has even seen me weekly if required. Otherwise, what about fentanyl patches or methadone (both generic)? I think it would be silly to convert your morphine ER to IR, even if your insurance and doctor would let you...the pain coverage wouldn't likely be nearly as good.

MS Contin doesn't last everyone 12 hours...its often dosed at 8 hours if needed (my doctor even started me at that); the prescribing info even says this. Pain meds are often found to need to be dosed more frequently than originally marketed for. Brand name MS Contin may last you longer. Kadian can also be dosed twice a day if once a day isn't working. Kadian or Avinza would likely give you even smoother coverage than MS Contin, especially if you were taking the MS Contin every 12 hours.

Don't be afraid to tell your doctor that a med isn't lasting the prescribed time, and see if it can be taken more often. This would go for switching to brand name MS Contin, or something new like Kadian. There is even a small group of people that need to take their pain meds on an even tighter schedule than published guidelines (for example, I need to take my methadone 4-5 times a day, instead of 2-3). Best wishes.

[alex44]

thank all of you we just got yet another new provider for meds - I checked their formulary on line NO 24 hr. meds listed. they do mention step therapy, I plan to ask my doc if there is a way to get an overide as this HAS been a continuing problem and she knows it and has probobly been charting it - Thank You P. Steve I am learning more and more every day and caring people like you make it possible, I may have to do as you said, with appeals and such but being that I can't do much of anything else, I have the time and a computer so that at least puts me in the game, that and a caring Doc. Again, thank you to EVERYONE.
Blessings
Alex44
Skypilot

[Mark N]

Alex, I just caught up with your thread and I hope you are getting a good answer from your insurance. As Steve said you never know what they will approve until you submit it and go through the review process if necessary. It gets frustrating when we can't get the meds that work best for us. Have you checked with the new pharmacy about getting the manufactures you want? Good luck this is a hassle we have to deal with but really shouldn't have to deal with it.

[Eva 14]

Alex, when I checked my insurance formulary the expensive long-acting meds like Avinza and Exalgo were NOT in the formulary, but it did say that the insurance would pay with "prior authorization" from my doctor. I was really afraid that that just meant there was no way my insurance would pay for it. But my pain doc called up my insurance and got the prior authorization on my Exalgo.

I find that Avinza works pretty well for my pain, but I get an annoying side effect of sweating when I'm on it, so that's why I'm switching to Exalgo. I'm still a bit scared that Exalgo won't work as well as Avinza, but we'll see.

The 24 hour meds really DO work 24 hours, at least in my experience. And you could always take one pill in the morning and another pill 12 hours later to make sure that your pain is covered.

I just wanted to let you know what has worked for me. Good luck with your insurance and finding a better med!

Eva