November 4, 2007 - 10:07pm
Okay all, I need your help and advice. As many on here know, I have been prescribed #330 10/325 Norco's for a while now (=11/day). Years ago I had tendonitis, then surgery for it, then developed nerve damage. I had a pinched ulnar nerve at my elbow and too much pressure built up in the radial nerve. I had surgery again to relieve all this, but it did not heal right. The radial nerve incision healed fine, but the ulnar nerve was place in a position directly under the skin and along the bone in my elbow, and it causes me excruciating pain quite often. I have to use my arm everyday, most all day and therefore require constant pain meds. If I use my arm for alot of activity then my old things begin to hurt again as well (the muscle from tendonitis, and the top of my arm from radial).
I am prescribed Lyrica (which makes me drowsy so I can't take much anyway), Lidoderm patches, voltaren, and Norco for my arm, but I have only been able to afford the Norco seeing as that alone was $260/month.
As everyone knows, the daily recommended max dose of tylenol is 4000mg, and I am taking 3575mg daily, so I am under the limit and have no problems...until now. I am FINALLY getting my medicaid back after almost a year, and just found out that they will only approve and pay for up to 3000mg of my meds. I go back to my doc this Thursday and will have to discuss something to deal with this, possibly trying ER meds again.
Long ago we tried the ER meds but without success. To make this short, we 1st tried Oxy 20mg-didn't help, then Oxy 40mg-didn't help. Then MS Contin 15mg-didn't help, then MS Contin 30mg-didn't help. After this my doc gave up and said we should stay with the hydrocodone (back then I took 6 10/325 Norco per day).
Any suggestions about what to do, or talk about with my doc? He has not been informed about any of this yet, I will have to do it on Thursday.
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
November 4, 2007 - 11:23pm
#2
Hydro dosing
Just a thought, but do you have a compounding pharmacy where you live? I have known of people that will get Hydrocodone made up 15/80 or even 20/80. Keeping the 80 mg of apap in the mix keeps it a C-III, I think. You might want to check it out. It could be the answer to your problem.
Good luck and take care.
Director
November 5, 2007 - 3:38am
#3
thank you gtrplayer and
thank you gtrplayer and director, those are both good ideas.
Gtrplayer- I am talking about 3000mg of acetaminophen, not hydrocodone. My insurance kicked in on the 1st so I picked up the last week of my meds (well, 6 days worth) with the Medicaid. I know everyone at the pharm real well so they explained that Medicaid would only allow me to have up to 3000mg worth of acetaminophen per day, thus turning my 6 day supply (66) into a 10 day supply.
I have thought about talking to my doc and pharm and just paying for the extra 60 pills or so per month (would be approx. $55.00), but I don't know how Medicaid will feel about that-they are strict on their policies. (And, for the record, I have NO problems with sticking to what they say. I may not agree, but I am just grateful to get anything from them!)
You are right on my dosing schedule, and it would be logical to also try splitting my script just like you said, but, Medicaid won't go for that. I could have a different script with a different dose, like 10/500, but not something with the exact same dose (10/325) as the other one. Then again, if they will only pay for up to 3000mg per day, it would probably be based on my total apap intake for ALL scripts, and the 650mg or 1000mg of apap daily in the 2nd script would probably be added to that total.
Director- I am not sure where a compounding pharm is, but I am sure there is one somewhere around here- I live in Indianapolis. I actually haven't looked into it b/c I've never needed it before, and I love my pharm and its people so much!
I actually was paying almost $100 more a month for my scripts just so I could stay at my pharm and not deal with new people questioning me and looking at me sideways every time I came in. I go to a local CVS that serves 1000's of people everyday, but everyone knows me so well that I come in and they recognize my face. I just say my name and they say, oh, another week's worth? They know my meds, dose, and everything.
Anyway, compounding might be something else to look into as well. I will keep that in mind when talking to my doc, thanks.
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
November 5, 2007 - 10:29am
#4
Normal release oxycodone
Normal release oxycodone (Percocet 10/325)? More potent mg per mg so you need fewer tablets per month.
Methadone?
Duragesic patch is covered in my state up to at least 100mcg/hr every two days.
Gabapentin is an inexpensive generic.
Most of my state's medicaid providers will not cover Lyrica or Lidoderm patches. They will cover lidoderm ointment with prior authorization, but usually they will only pay for it for FDA approved indications.
Comparison shop different pharmacies. Hydrocodone 10/650 wholesales for no more than $60/500. (my catalogue doesn't list hydrocodone 10/325 specificly, but it should be comperable.) Your CVS may price match less expensive pharmacies so you may not have to change pharmacies.
If you pay cash for a prescription, the pharmacy cannot report that to your insurance company, even if it is medicaid. So medicaid should never even know you are getting a second script.
November 5, 2007 - 12:03pm
#5
Compounding Pharmacies
Just look in the yellow pages of your phone book. There are probably several in your area. I think it's the way to go, unless you try the Oxy like Dr. Lois suggested, or another med like the patches.
Director
November 5, 2007 - 5:46pm
#6
Xodol 10mg/300mg You would
Xodol 10mg/300mg
You would atleast get closer to your normal 11 per day with 10 per day. Im not sure if Medicade will pay for name brand medications, I am unfamiliar with Medicade.
November 5, 2007 - 7:15pm
#7
I would think the oxycodone
I would think the oxycodone IR's would work. I'm sure you know they come in 5's 15's and 30's I remember years ago when I was on a lot of hydro's 5/500, then my doctor had me try Hycodan which is meant for a cough suppresent but it also worked preety well for the pain There is no tylenol in it and they used to come in tablet's but I do not know if they do now. Also they had Tussionex tablets too which were 5 mg per tablet of hydro but worked out to be 10 mg of hydro somehow. This was 25 yrs ago so they might very well have been discontinued
November 5, 2007 - 10:45pm
#8
Dr. Lois, I think you are on
Dr. Lois, I think you are on to something- its also something I have thought about but not sure about asking to switch up. My doc is cool though, I've had him for years, so I'm not afraid of doing it, you just get nervous, ya know?
IR oxy (percocet) I think is something worth a shot, as well as methadone.
I don't have any problems with my other scripts, I get the name brand Lyrica and Lidoderm with no problems. I just had to have the prior auth first, but that was handled a long time ago. It will be nice to get all my meds back again.
I know I can just go look it up in the conversion table, but off hand do you know what I would need?
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
November 6, 2007 - 6:43pm
#9
Are you not happy with
Are you not happy with Hydrocodone anymore?
Also 7.5mg/325mg Percocet would basically equal the Norco 10/325, its actually 6.67mg Oxycodone=10mg Hydrocodone, but its better to try the 7.5 Percocets than the 5mg percocets from experience. As far as the methadone, thats a pretty tricky one to convert so I will leave that one up to someone with more experience.
November 6, 2007 - 9:39pm
#10
yes I still like the norco
yes I still like the norco but my insurance that just go reinstated will not cover my entire script- I take 11 10/325 per day, which =3575mg of tylenol, and Medicaid will only cover 3000mg of tylenol per day. No, I don't want to go down to 9 pills per day b/c then I will not get enough pain relief (I barely do now anyway).
My doc once said to me that they expect you to build a tolerance usually in 6 months. I have been on this same script for 6 months now anyway, so it stands that he would expect me to have built a tolerance and may already be prepared to discuss raising my meds if needed.
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
November 6, 2007 - 10:20pm
#11
Thats why I thought Xodol
Thats why I thought Xodol 10/300 would be a good choice, seeing that you could still get 10 pills a day paid for by Medicaid, and if you had to you could have your doc write you a script for the other 30 for Norco10, so you could get generic and pay cash.
Another thing, have you actually verified this situation with your doctor or another pharmacy? It seems to me if they (Medicaid) would put a restriction on it, it would be at the max daily suggested doseage per the FDA and Manufacturer.
September 25, 2009 - 10:13am
#12
"My doc once said to me that
"My doc once said to me that they expect you to build a tolerance usually in 6 months. I have been on this same script for 6 months now anyway, so it stands that he would expect me to have built a tolerance and may already be prepared to discuss raising my meds if needed."
Thank you for posting that info!
I've been on the same script now for almost 2 years. My doctor and I are both worried about the tylenol in the Noroc to go much higher and I've tried lots of other pain meds without much success (not to mention horrible side-effects). The hydrocodone works well for me.. maybe a compound pharmacy is the way to go. Guess I'll have to ask her and see what she thinks...
Pay for the extra 30 tablets out of pocket, maybe? I'm kind of rushing, so I don't even know if I did the math correct.
10mg * 300 = 3,000mg
10mg * 31 = 310mg
You do mean they will only pay for 3,000mg of Hydrocodone, correct?
I have no idea how insurance companies operate, and in all fairness, have no interest in them. I hate dealing with them, but someone with insurance knowledge might be able to tell you whether or not they will only pay for 3000mg per prescription.
So, it might be feasible that the doc write your normal script, but for #300 instead of #330.
Then, for the remaining 30 tablets, change the dosing instructions since it would be a different script with different dosing requirements.
You were taking 3 tablets 3 times a day, and two tablets at night, correct? Maybe your doctor can write one script for 3 tablets 3 times per day, and another script for two tablets at bedtime. Just a thought, and perhaps someone with more knowledge on insurance companies can help out.
gtrplayer