Interesting psychiatrist appointment...come along on my Mr Toads wild Ride!

[InsaneCdn]

Somewhere else on this site is a thread with an announcement about generic Concerta... try searching for that.

Meanwhile... Ritalin is methylphenidate, I think - and yes, folacin, concerta and a few others either have the same chemical config or related.

The difference with Concerta is... slow release. Ritalin SR is NOT anywhere close (but cheaper). Standard ritalin is CHEAP - I can afford the non-generic even without a drug plan - and you can stage your pills to take, for example, 5 mg every 3 hours, and get a good bell curve... but its a total PITB to do it that way. (I've done it...)

Doesn't the pharmacy know if there's a generic for Concerta?

 

[InsaneCdn]

Do not bother with the generic for Concerta.
I was trying to figure out why the drug ins. plan here actually pays for Concerta when there is a generic "available".
Turns out - its no where near close enough to the same... so, drug plan (for the kids) will pay for Concerta.
Doesn't cover adults... so I'm stuck with Ritalin and timed doses!

You basically have two options... either pay for Concerta (or go beat up the ins co to pay for it because the doctor says anything else will cause drug reactions with what you're already on...!), or ask about other long-acting stims...

 

[DammitJanet]

What is the name of the generic for Concerta?

 

[DammitJanet]

On of a dang gun....all of these dang drugs are the same dang thing!!!!!!!!!!!!!!!

 

[InsaneCdn]

Janet -
The supposed generic equivalent of Concerta is: Novo-Methylphenidate ER-C or Teva-Methylphenidate ER-C (there was a name switch going on at some point).

Warning - delivery mechanism is no where near as controlled or smooth as Concerta.
Do not take the generic without getting permission from psychiatrist.

 

[DammitJanet]

Yeah I noticed that but what just kills me is that when you google all the same medications under the Concerta, Focalin, Methylin, Ritalin family...they all say...Methelphendate. Thats it. Nothing more, nothing less. Some are extended release, some are shorter acting, some are liquid, some are chewable. Same exact medication. Idiotic that insurance would pay for one and not the other.

 

[InsaneCdn]

For some reason not yet fully understood... there are a number of medications families that do NOT "genericize" well. Methelphendate is one of those.

My original psychiatrist - the one who did my ADHD diagnosis - told me to NEVER go generic on methelphendate - always stick to the brand name - they did not understand WHY this was, but clinical observation was proving that the therapeutic effect is not the same.

Its even more noticable with Concerta. The delivery mechanism is the part that sets Concerta in a class by itself. They don't have "chunks" of release... much more slowly, therefore better impact. The kids are on Concerta, and we can only afford it because of the kids drug plan here. I use brand-name Ritalin - costs more than generic, but WAY less than Concerta.

Drug plans here didn't pay for Concerta until about 2008, although the drug was in use in Canada in about 2006 or so if I remember right.

The only good part about the methelphendate link between these drugs, is that they can be combined - you won't likely need that, but in case you do... if Concerta doesn't last long enough, a small dose of regular Ritalin before supper makes the evening go better (homework and such). It isn't combining different chemicals - just the bioavailability (and whatever else is affecting therapeutic results...) and timing of delivery that are affected. It also means you can switch between them at will. If somehow tomorrow we ended up with a drug plan that covers ME, I would be able to get the doctor to switch me from Ritalin to Concerta - stop one today and start the other tomorrow.

Wasn't there a thread in the last few months about ways to get low-cost drugs? Wonder if that might also apply here??

 

[InsaneCdn]

The reason insurance doesn't want to pay for Concerta... is simply the cost. It IS outrageous. Beyond most people's ability to pay. But it IS a superior member of the methelphendate family.

 

[DammitJanet]

Wouldnt Focalin be just as expensive since it is newer than Concerta?

 

[InsaneCdn]

Not necessarily. I'm not familiar with that one - we don't have it in Canada yet. So I don't know its delivery profile. But - part of the cost is the number of patented processes required to make the stuff... and Concerta is complex. So... its worth asking your pharmacist about where the various medications compare in price, and which have a good track record on sustained-release.

I know that with Mom's heart medications... (and I do NOT know what she's taking, exactly) she's said that the newest one is less expensive than one that's about 5 years old - but both are more expensive than generic.

 

[InsaneCdn]

Janet, the more I think about this...

You might want to do what I'm doing... can't afford Concerta for me, so I'm sticking with brand-name Ritalin.

Most common Concerta dosages are 18mg, 36 mg and 56 mg (others are possible by combination... 2x36, or 36+54).
Concerta18 is roughly equivalent to 3 x 5mg of Ritalin
Concerta36 : 3 x 10mg
Concerta54 : 3 x 15 mg

The advantage of the Concerta route is that you will get between 8 and 12 hours of consistent medications... really great for students, or people with a day job.

The advantage of the Ritalin route is that you get to pick and choose exactly when you want to have your brain "clear". For example - I live or die based on my afternoon nap - gotta have it. So, I don't take my second dose until after my nap. If we're invited out for supper or something, I don't take my last dose until just before we leave. One dose gives me 3 "top" hours and about 1.5 "bonus" hours... its amazing what you can do with 3 hours. BUT... If I have a heavy day at work, I can take the first two doses 4 hours apart, and get 6 "top" hours out of seven consecutive hours... and THEN take a nap. And still have a dose left for going out that evening.

If you can't get Concerta (because insurance won't pay for it), I'm not sure you need to get worked up about the other new ones right now either. If you can handle the up-and-down of it, Ritalin actually works well. And it would be a cheap way to tell if this whole class of stims will work for you or not. If it doesn't work, you haven't invested much $$. If it does work... then you can fight for the new-and-improved stuff and it will be worth the fight...

 

[Steely]

On a side note they often prescribe Provigil for Alzheimer's patients, and people who are on a lot of medications that could distort or dampen their thinking. They also give it to chemo patients. I got the Dr to XR it for my Dad in his last months, and he absolutely loved it. He could focus more, and stay awake during the day, where before he was tired from the chemo. He even tried to convince the Dr to give it to him twice a day. LOL. This is my 70 yo Dad who had refused to take anything more than aspirin his whole life. So if Concerta doesn't work, it might be worth a chat with the Dr about Provigil.

 

[DammitJanet]

Well I got the official denial of prior approval phone call on concerta this morning so I called the dr again. doctor wanted me on 36 mgs. Receptionist said she hoped they would contact them. I think I am going to call her back again right now. Im heading to the doctor between 2 and 6. Just got off the phone.

 

[buddy]

Yeah, we go back and forth between using concerta (also denied by son's insurance but they approved it after doctor wrote appeal, but he is a kid so we will see in a few years--luckily he has that enzyme issue so things get approved easier)

Anyway, on the concerta website and thru our docs they have explained that Concerta is not really a smooth even dose even in the most text book of blood levels...(of course we all know it would vary among some people, but it does anyway)...it is better than just ritalinXR in how it maintains levels (They say...smile). But I have been told that Concerta works kind of like 30% initially...builds to 70% then ramps down. Since mine needs it all day till bedtiime (luckily it has NO effect on sleep or appetite for him) at 6 hours after first dose he gets dose two which as it is building, the other one is lowering.....

So sometimes, it is just easier to use Ritalin. If he wakes late I never give him dose two of Concerta. I have PRN ritalin and use that 9 to 11 hours after concerta dose depending on the activity and how late he is to be out. Other days just easier to do the Ritalin. Problem we have with Ritalin is the rebound he as when it wears off at exactly 3.5 hours after giving it! He goes crazy, jumping, cartwheels etc. I am always prepared....evening medications ready at hand or whatever at that 3.5 mark so that we dont have to risk a dangerous situation.

 

[DammitJanet]

Well they gave me methylin I think 20 mgs two times a day. We shall see. I pick up the medications tomorrow morning.

 

[InsaneCdn]

So... how is it going with the medications?

 

[DammitJanet]

There must be some kind of cloud over me that says Im just not supposed to start them this week. My pharmacy is a little mom and pop store that I really love for many reasons but for a very few things they can be a pain. This one time is one of those times. They have never had another person on this drug so they didnt have it in stock so they had to order it and it will be in Monday. Argh. Now the best thing about this place is that once you do start on a medication, they will make sure that they will never run out on you. They are only open M-f 8-5 but that works for me. Filling a script never takes more than 5 mins if you just have a couple 10 minutes if its a fairly large batch. No more telling you to come back in 3 hours. Or tomorrow. except in rare circumstances.

They have always asked me to call them if I know I am changing a strength of a medication so they can be sure they have it in stock, especially if its one of my important ones. I love mom and pops. I hate chains. I had pills stolen, scripts lost, waited hours and hours and was treated rudely. No way.

 

[Hound dog]

Janet, stick to the mom and pop.

We don't have any. I sure wish we did.

 

[InsaneCdn]

Sure - leave us in suspense over the weekend!But... definitely support using the kind of pharmacy that doesn't let you down. Ours isn't quite as good - I phone refills in before I leave, to give them time. BUT once, I needed an emergency script for husband (he NEVER needs medications - this was pain medications due to dental surgery) - went to the wicket with the script... lined up 10 deep waiting to get scripts - but I was out of there in 5 mins. Having someone you can work with means way more than a bit of inconvenience.And, because it doesn't have to build up in your system... you'll know real soon.

 

[DammitJanet]

Oh in a real emergency I can take my scripts to a chain store. If Tony hadnt left the script at that store I could have gone to CVS or Walgreens for this month and had my store order it for next month but he did so whatever. I can wait.

But if its something really dire like I need antibiotics on a late Friday night or Saturday and mine isnt open I can got to a chain. My information is there. Because I get Medicare part D and medicaid, everything is in the computer so I dont have any issues with insurance.