Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

NEED YOUR ADVICE, Opana not cover by INS.

SteveSSteve Posts: 73
edited 06/11/2012 - 8:48 AM in Chronic Pain
Finally found a new dr., he wrote Opana 20mg X 2, bumped up  twice, now 20 X 4. Now Ins. wont pay, despite erroneous approvals and overrides . Meperidine or Demerol is the closest thing, which he wont write for.

i need to find something which he will write that will help with the pain. Even the Opana was only so so. I noticed a point of diminishing return after 20mg X 3 a day, now 20mg X 4., no help. Anyway, what's an affordable alternative??  The dr. says it's my responsibility to find an acceptable one, but he insist on multiple choices faxed to him. He won't give me the secet list, fearing perhaps that i'll pick the most FUN one? I don't know. Being in pain is such a blast.

Thanks guys, when all else fails, I know I can ask you.


  • Can't you call your insurance company and ask them exactly what it is they will cover, have them fax you a list perhaps, then send a pigeon over to his office with the list and a pen and he can circle the drug of his choice. Jeez, this is kind of ridiculous. I can't believe you have to go thru so much baloney to get some help! I'd be blowing a gasket and chewing someone's butt I suspect, because this kind of run around stuff gets old! You're right, being in pain is so much fun, then top it with all the added stress of wondering how you are gonna get someone to help or do the right thing - I feel for ya buddy!
  • The cheap stand-by - is MS Contin - Extended Release Morphine.

    Yeh - I was away on business and did not get to fill in the paperwork for some things, but the tone of the letters on my end, were fun to read.

    1- - No
    2- Maybe
    3- Yes - Sir - you are approved until your gone. You don't need to apply again, we get it.

    Funny thing - the side effects were so bad, after 60 days - I could not use the med. In effect they won, but it was round-about!
  • What did your insurance list as the alternative? How about Exalgo?
  • Ins pays for Demerol aka Meperidine. Dr won't won't write it. The INS co won't budge, although I haven't tried a formal approach yet.

    Now I'm desperate enough to pay for the cheapest alternative I can find. I will check the price of Exalgo and MS Contin. I'm a bit afraid that he'll think I'm SHOPPING, asking for these different drugs. I'm in a trick bag. Maybe some of you remember my post, "Denied Pain Meds."

    Thank you guys for the advise. It gives me somewhere to start.
  • Tell him that you heard that these were cheaper, but you have no idea. Leave it up to him to pick, and tell him, "look I really do not care what you pick, but as far as I can tell, we are both agreed that I do need to have the pain controlled. What can you recommend?"

    That is exactly the way I have worded it to my Dr.
  • Thanks guys. I'll keep you posted.
  • Get something in writing that says they are denying coverage. I'm alittle surprised because I didn't realize that they could pick and choose what to cover. Maybe insist on generic but if you have a prescription I don't understand what the basis of the denial would be.

    Just make them put it in writing. That way you can show that to the doctor to prove that you are not the one looking for something to substitute.

    The other thing is ask the pharmacist. They can usually give you good alternatives and they also know what the insurance companies prefer.

    Another thing struck me when I re-read your post. If I read correctly you are saying that the Opana was not working or not working as well. What about trying some neuro drugs? I hate to see you fight to get something that won't work at the end of the day.
  • Hi Ktris,

    I recall you mentioning the neurp drugs in the past. I've been on lyrica for 5 months, 50mgs twice a day. It just isn't working. I've tried it in the past and no help. This time i really tried. Slowly increasing for 25 twice. Also, tried increasing, but just can't get by the side effects, and never noticed any relief.

    I hate the constant ringing in my ears and bad dreams. Also taking Cymbalta, it helps depression and may help pain, but has no side effects. I plan to increase it after I find a good pain med.

  • Steve, talk your Dr about hydromorphone, it is a close relative to oxymorphone. Most ins carriers will approve it because there are generics available.
  • Exalgo is the extended release for hydromorphone, but I'm not sure whether your insurance would cover it, as it's fairly new and also brand name.

    Demerol is not something I've seen used frequently for chronic pain (the extent of my experience being pretty much, um, here) but maybe doctors don't like it. MS-contin and oxycontin are the two most frequently used long-acting, but oxycontin is also not available in generic, I believe. Another option is the fentanyl patch, which is also available as a generic.

    I have personally tried ms-contin and fentanyl, and didn't find either of them remotely fun, so that's a plus ;)

  • Demerol was once the most frequently prescribed opioid for moderate-severe pain, but it's been out of favour for many years now. It just isn't suitable at all for chronic pain, because it has a metabolite (normeperidine) which can quite easily accumulate to toxic levels when taken regularly. It's also very short-acting - I had it for post-operative pain about 15 years ago and it's only good for 2-3 hours at most.

    I guess the least expensive alternatives to something like Opana would be morphine and methadone.
  • has been "black boxed"...you will not find many practitioners willing to use or prescribe it now.
    Medical-legal rationale.
  • jlrfryejjlrfrye ohioPosts: 1,110
    While you are trying to come up with a solution to your medications Opana does have a patient assistance program.
    At least you could get help paying for your meds until another medication is prescribed.
  • Thanks guys, I got the ms-contin I've had it before and don't like the toxic feelings it give, but the15mgs X 3 per day should help the pain. I don't suppose that there is anything else beside lyrica, is there? I've tried the anti-depressants, anti-seizures, tyrptilines and m&m's.

  • Yes, there are several. All of the anti-seizure meds have off-label uses as nerve pain meds.

    Neurontin is the main Lyrica competitor, the most effective after Lyrica.

    I take Topamax.

    Do a search on "anti-seizure meds."

    But you're taking 100 a day, and many people don't notice a difference until 150-200 mg a day. Or are you having really unpleasant side effects? The relief does't tend to ramp up, it tends to just "turn on" when you hit a reasonable dose for a lot of people (from my experience, this is what happened).

    Thanks for the info about Demerol, Sleeprgirl. Steve, can you let your insurance company know that their suggestion for an alternative to Opana is inappropriate? If they are going to practice medicine, at least hold them accountable for doing it right or hearing an earful from you!
  • I've never turned down an invitation to straighten out someone on the phone. I sure will call the INS co. By the way, I'm on lyrica and cymbalta. I forgot to ask me doc today about Topamax. Although, I think he likes to try one methodology at a time. I will take all of your input as soon as he's ready to make a change. Thank you guys! Your my new best cyber friends!
  • YOu take both? I thought they were similar meds. I know I was on Cymbalta and when the side effects got too bad I switched to Lyrica. Didn't know you could do both.
  • If I am understanding this correctly - you need meds for nerve pain specifically - correct?

    Just making sure I am on the right page here.

    I am so so sorry Steve for all you have and still are going through :(

    Could you ask your "friend" the pharmacist?
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Lyrica and Cymbalta are not similar, you can do both (and I have!). Their only similarity is that they both treat pain.

    Steve, how is the Morphine working? Feeling better?
  • Thanks for asking? You guys truly are my best new cyber friends. It is coming around, the effects of the ms-contin that is I'm now on 30 mgs bid. Next week we will reevaluate this.
    I can tell you that I was abable to lounge in bed comfortably like I can't remember since before my injury. I also doubled my Cymbalta to 60 mgs bid.

    Once again, thank you guys for thinking of me. It really means a lot.

  • Hi Steve and Medic 008, my doctor just put me hydromorphone and my insurance paid for it. It's like morphine but not as bad side affects. I was having breathing problem on morphine, it felt like I had asthma!

    Steve, I hope things work out for you..


This discussion has been closed.
Sign In or Register to comment.