Alternatives to Hydrocodone

[Eternityroad]

Hi,
I recently found out that my health insurance carrier has slapped a $175 deductible for tiers 3,4,5 medications. This includes Hydrocodone which I use along with Kratom to control my RLS and with good success. I mostly use the Kratom but I need Hydrocodone when I have to attend functions where it would be inconvenient to prepare the Kratom, like movies or the theater. Also I take it from time to time so I don't build up too much of a tolerance to the Kratom. I have no info on how much the price would increase (I am paying 15$/month for 30 tablets of 7.5-350). Does anyone know of a less expensive substitute opiate that I could use effectively ? Can't talk to my doctor about it because she doesn't know enough about RLS and what drugs are effective in handling it. Appreciate any and all advice.

Ken

[ViewsAskew]

I have to zip my lip when it comes to insurance in the US...

You can usually do a search on Google (maybe other search engines, too) and see what the price of any prescription item is at the places around you. I just did it but it is for the Sacramento area, where I live. If you do it, it should be for your area. Good RX and Well RX are two places that will give you options. You have to make sure the options are set correctly for quantity etc.

https://www.wellrx.com/prescriptions/hy ... earch=true

https://www.goodrx.com/hydrocodone-acet ... ugId=29968

[Rustsmith]

I just looked at the pricing of a couple of opioids at the mail pharmacy that I am forced to use. Hydrocodone was by far the most expensive one that I checked. Since you use it infrequently, you could shift to one of a Sch 2 meds where you only get 30 pills/prescription. And if you need to stay with Sch 3,4,5, then you might want to discuss changing to generic tramadol, which my pharmacy quoted as far less expensive than generic hydrocodone. But there are two forms of tramadol (regular and ER) and the ER form is as expensive as hydrocodone. For the sake of comparison, my uninsured price for a month of methadone is $25 although finding a doctor who can prescribe it is a major pain. My cost for a similar quantity of hydro would be $150.

[Eternityroad]

Awesome! Lots of helpful info. Thanks.

[Eternityroad]

you could shift to one of a Sch 2 meds

Valium (Diazapam) is a tier 2 medication and so not under the deductible I mentioned. But is Valium a acceptable medication for controlling RLS?

[Rustsmith]

Valium is a benzodiazapine used to treat anxiety and is a sedative. It is not generally used to treat RLS. Benzos were used in the days before the introduction of the dopamine agonists, but clonazepam was usually the benzo of choice in those days.

The Sch 2 meds that are used are things like oxycodone, methadone, morphine, and hydromorphone, Suboxone is a Sch 3 med that is also effective but is also on the pricey side compared to the older generics in Sch 2.

[Eternityroad]

The Sch 2 meds that are used are things like oxycodone, methadone, morphine, and hydromorphone, Suboxone is a Sch 3 med that is also effective but is also on the pricey side compared to the older generics in Sch 2.
Steve

Thank you. I will show the list to my doctor. But I am surprised that morphine would be Schedule 2. I would have thought it more potent and dangerous than hydrocodone. I once had a morphine drip when I was in ER for kidney stone. I didn't know it came in tablet form as well.

[Rustsmith]

The Sch 1 list does not have anything to do with strength, they are the illegal drugs. Even fentanyl is Sch 2 and it is far stronger than morphine (which is a close cousin chemically to all the other opiates like codeine, hydrocodone, oxycodone, etc). Cocaine is Sch 2 also. Cocaine is Sch 2 because it is occasionally used as a local killer (primarily for ENT use) but it requires that the doctor have a special license. I had a friend who had an ENT doc spray some in his nose for a severe sinus infection when nothing else helped. He said that it worked great.

The Sch 1 are the drugs that the federal government considers to be illegal and to have no medical benefit. The Sch 1 list includes things like heroin, ecstacy, LSD, meth, peyote, psilocybin (magic mushroom) and currently marijuana (but that may change soon to become Sch 2 or 3). Although I understand some of these classifications, others (like MJ) just show how out of touch the feds are. As an example, the feds do not currently have an approved treatment for PTSD other than talk therapy. I have PTSD due to medical trauma and talk therapy was a total waste of time. In states that allow it, there are groups that offer treatment using low doses of hallucinogens along with a therapist/guide during treatment that clinical trials have shown are very effective. Most of the drugs used for these treatments are all Sch 1 due to the potential for abuse outside of a controlled setting. But then, fentanyl is currently one of the most abused drugs and it is Sch 2.

Enough of my soap box ...

[Eternityroad]

Steve,
I think I had the wrong idea about the Tiers. I thought the higher you go on the schedule(tier) the more dangerous and/or illegal the drugs are. From what I can see now the higher tier drugs are the more expensive drugs, example: certain cancer drugs are tier 4 drugs. This misconception was why I thought morphine should be in a higher tier. Anyway, I didn't mind the soap box. Always can learn something.

Thanks,
Ken

[Eternityroad]

The Sch 2 meds that are used are things like oxycodone, methadone, morphine, and hydromorphone, Suboxone is a Sch 3 med that is also effective but is also on the pricey side compared to the older generics in Sch 2.
Steve

Soooo...Tiers are different than schedules...All the schedule 2 drugs mentioned in the quote are Tier 3 in the Medicare list. Suboxone is tier 3 in United Health Care plans (which is my plan) except that certain of its generics are tier 1. So suboxone generic is a possibility.

[Rustsmith]

It is ridiculous that the drug plans have a different form of classification than the FDA/DEA schedules, but I guess that it comes down to the prices that they pay the suppliers vs what they figure that they can charge their customers, hence profits. My pharmaceutical benefits manager takes the easier approach, they just jack up the price of the meds that they don't want to handle.

There was a time a few years ago that CVS (who owns Aetna, the insurance company that operates my former employer's self insured program) refused to fill opioid prescriptions (thankfully they had not bought Aetna yet). CVS backed down when a class action lawsuit was filed in 2020 that claimed CVS was in violation of the ADA and the Affordable Care Act.

[Eternityroad]

Steve,
Soooo ridiculous. I called United Health Care. My cost for Hydrocodone until I meet my deductible is 200$ for 30 tabs of 7.5-325. After that it is 15$ for 30 tabs. Tramadol is 200$ before deductible and 47$ after. I am just not going to use the opioids. I can carry pre-mixed Kratom powder with me and a small bottle of water. Meantime I have 30 tablets left of the Hydro and will save them for emergencies.

[ViewsAskew]

Steve,
Soooo ridiculous. I called United Health Care. My cost for Hydrocodone until I meet my deductible is 200$ for 30 tabs of 7.5-325. After that it is 15$ for 30 tabs. Tramadol is 200$ before deductible and 47$ after. I am just not going to use the opioids. I can carry pre-mixed Kratom powder with me and a small bottle of water. Meantime I have 30 tablets left of the Hydro and will save them for emergencies.

Can you just use an independent pharmacy and not use the insurance? That is what I do - I pay much less that way.