Actiq or Fentora

[theoutlaw77]

I really need your help! Is anyone else using Actiq or Fentora for breakthrough pain? If so, does your insurance cover it? I keep on getting a denial since the medication is to be for "cancer pain." I have cited the studies that show that IC pain is worse than advance stage cancer pain, but still no luck.

I have been able to use these medications (Fentora has only been out for a few weeks) with coupons from the drug rep, but there are no more coupons. I am in this huge appeal process with my insurance company, and any info. or backup I can get would be greatly appreciated!! I have a hearing scheduled for Nov. 8th.

Also, does anyone know anything about the ERISA law?

Thanks!!! Jonee

[IC SARAH-CPP]

Im sorry Jonee, I cant help you there. Actiq and fentora are the only meds my doc refuses to prescribe. i was pretty suprised when he said no but he was pretty adamant, so I can see you running in to problems with the insurance companies.
I dont know what to tell you. I know someone else said they were paying 1600 a month for 30 actiq suckers, so I know they are insanely expensive.
One thing I dont get is that the patches also say on the website that they are for cancer, but most insurance companies will pay for those? Hopefully your hearing goes well!
Love Sarah

[theoutlaw77]

The thing that does not make sense is that Actiq and Fentora contain the SAME medication as the Duragesic patch (which my insurance DOES cover) !! They are all Fentanyl based. The only difference is the Actiq and Fentora are immediate release. I have brought this point up during my appeal process, but I honestly don't think they are even looking at anything that I send them. There is no way that I could afford to BUY these medications.

[IC SARAH-CPP]

I know, the whole thing is so insane. My doctor really freaked out when I asked for Actiq. I was shocked because he has been open to almost anything I suggested for pain mgmt and told me the patch was "really weak" compared to oxy, mscontin, and methadone. He said he had never prescribed Actiq and never would. That it was like giving yourself an injection at home and was unacceptable.
You have probably already thought of this, but can you contact the company and ask about those programs for free meds they have? I know you said you are using coupons, is that the same thing? This makes me SOO mad!! You find something that works and they snatch it away?
Please keep us posted on the outcome of your hearing!
Love Sarah

[theoutlaw77]

I am not sure what the free meds are that you are talking about. It may be the same as the coupons, but I don't know. The coupons come from the drug co. not the insurance co. Usually, they give them to the dr. and then the dr. gives them to me with the script. But, I did have one drug rep give the coupons directly to me.

I have been told that the Fentora is cheaper (though I don't think by much) than the Actiq, so I may have a chance with that. That is something that will be brought up at the hearing. It was not even out yet when I first started this appeal process. But, now I am asking them to consider covering it if they will still not cover the Actiq.

My dr. said that there is supposed to be a generic coming out at the end of this month. Maybe that will change things...who knows.

[Moonheart]

From what I read on the package insert (on their website) Actiq is not only for cancer patients only, but for opioid tolerant patients as well. Such as patients who are chronically on 60mg or more of Morphine,etc. It seems that the risk of respiratory failure is too high if someone isn't already totally tolerant to another opioid.

[ICNDonna]

Has your doctor written to the insurance company? Sometimes that helps.

Donna

[Moonheart]

I think unless someone has been on opiates long term and are tolerant, most likely docs won't prescribe this. I don't know if that is the case here or not.

[iris2]

What I really wanted to write here was that my current doctor wrote a script for fentaryl instead of fentora and it needed to be pre approved. He is terrible at this stuff and they denied it.

if you are interested in trying Fentora the company, Cephalon will help you. Get in touch with them and ask for the “Fentora Reimbursement Assistant Hotline Patient Reimbursement Consent Form” Call them at 877-433-6867. If you fill out the form and have you doctor fill out his part they will get in touch with him or you and help you with the pre approval or the appeal. They have been very nice I have yet to see how helpful they will be. I will post it if anyone is interested.
I am separately trying to get off the Lyria and hoping that this will help. I also need it for an almost instant breakthrough pain relief.

I have been on Lyrica for about a year. I am confused, sleepy, tired, dizzy, have gained about 40 pounds (have been very thin my entire life) and am unable to think straight, have memory problems and cannot drive. I have to say that when my frequency got so bad nothing world help that the Lyrica did and it helps with the pain also.
I take oxycontin and have tried several other long term narcotics. I also took morphine IR for breakthrough pain for several year. I started having a relationship last year and that is what killed me. That is when I had to start taking the Lyrica and increase my oxycontin. I recently told my doctor that the morphine was not strong enough anymore and he prescribed diloudid. It works I guess but it makes me high. I take enough oxycontin that i do not have breakthrough pain but then I have chronic constipation which flares my I,.C.

In 2007 I took fentnora for my breakthrough pain and it worked better than any of this stuff I do not want to try the patch because I will end up with the chronic constipation again. i need to not have constant pain medication in my body. At least in the past that has worked well. I don't mind having some breakthrough pain but it comes on so fast now and I do not have anything that works fast like the fentora. By the time I get any result I have spent most of my day in pain and ma exhausted. The Lyria has me me extremely depressed.

What I really wanted to write here was that my current doctor wrote a script for fentaryl instead of fentora and it needed to be pre approved. He is terrible at this stuff and they denied it.

if you are interested in trying Fentora the company, Cephalon will help you. Get in touch with them and ask for the “Fentora Reimbursement Assistant Hotline Patient Reimbursement Consent Form” Call them at 877-433-6867. If you fill out the form and have you doctor fill out his part they will get in touch with him or you and help you with the pre approval or the appeal.
I am separately trying to get off the Lyria and hoping that this will help. I also need it for an almost instant breakthrough pain relief.

Appologies for being so loquacious.

[Mothergoose]

My Dr. told me to take miralax daily and it works well for me for C. I have IBS-C long before painmeds. I have tried lots of fibers etc, Miralax has worked the best and caused the least problems for IC for me.

[iris2]

I am so glad you found something that works for you. I have some IBS but it is related to the I.C. The IBS flares the I.C. so it is very important for me to have it under control. I am sorry you have to deal with both diseases. I hope the best for you.

My doctor prescribed miralax to me a few years back and it was way too strong for my body.

In the hospital the doctor suggested taking it with some fiber and it helped immensely. Maybe that might help someone.

Thank you for the suggestion. You are very kind,

iris2

[Mothergoose]

One of the nice things about miralax you can ajust the amount you take. Mine is IC related too, if I get C it really flares my IC.

MG