breakthrough-cancer-pain-6 subsys coupon



What causes breakthrough cancer pain?

Breakthrough cancer pain, or BTCP, is brought on by many different factors and varies from patient to patient. Some cancer patients experience BTCP as a result of "incident pain" or after doing an activity such as walking, lifting, etc. Many patients have BTCP for no apparent reason.

Does SUBSYS replace my current medication for my constant pain?

No, SUBSYS is created to work along with your current prescribed pain medication and to ease your BTCP. In fact, patients must remain on their around-the-clock opioid when taking SUBSYS.

Will my prescribed painkillers treat breakthrough cancer pain?

Treating BTCP by simply raising the dose of a traditionally prescribed long-acting pain medicine may result in overmedication and increased side effects such as constipation, sedation and confusion.

How does this spray work?

SUBSYS is a fentanyl sublingual transmucosal medicine, which means the fentanyl medication is quickly absorbed underneath the tongue. It minimizes the amount swallowed and absorbed in the stomach or intestines like traditional oral medications.

What is a Prior Authorization (PA)?

In an effort to control costs, Managed Care Organizations (MCOs) often limit access to brand-name medications, which can often cost more than generic medications. Prior Authorizations are one type of MCO process aimed at managing access to certain drugs only to those who truly need them. MCOs may require a prior approval with a medical justification, especially in instances when a less expensive option is available.

What is the INSYS Reimbursement Center?

A dedicated team of specialists will assist with logistics throughout the Prior Authorization process. Your Healthcare Provider must "opt-in" to the INSYS Patient Services Center (PSC) program by signing Health Insurance Portability and Accountability Act (HIPAA) compliant forms for each patient. He or she is also responsible for providing any medical necessity justifications. The services conducted by the PSC are provided at no cost to the patient or healthcare provider. Additionally, the patient may be eligible for free product during the period of time when the Prior Authorization is in process.

How does the Prior Authorization process work?
  1. A healthcare provider prescribes a medication.
  2. The prescription is presented at the pharmacy.
  3. The pharmacist enters the medication information into the computer system.
  4. The pharmacist may receive notification from an MCO that a Prior Authorization is required (the prescription is denied until a healthcare provider provides a justification as to why the medication is needed).
  5. The pharmacist informs the patient and calls the healthcare provider's office.
  6. The healthcare provider then either allows the pharmacist to switch to a medication currently approved by the MCO, or informs the pharmacist he or she will request approval from the MCO (the Prior Authorization).
  7. The healthcare provider completes the appropriate forms and/or calls the MCO to seek approval.
  8. The MCO either approves or denies the request for medication. If denied, the healthcare provider and the patient may appeal the denial.
What does a patient have to do to seek Prior Authorization approval for SUBSYS?

Nothing. A healthcare provider or a staff member in their office will need to opt the patient into the INSYS Reimbursement Center by filling out the appropriate form. A dedicated specialist will assist with logistics throughout the PA process.

What if the Prior Authorization is denied?

If a Prior Authorization is denied, a healthcare provider and/or the patient can appeal the denial to the MCO by resubmitting the Prior Authorization form and offering additional medical justification. If a patient and/or healthcare provider disagrees with the MCO denial, they may request an external review from a state board. INSYS Therapeutics also has other programs that may provide assistance.

SUBSYS® is a strong prescription pain medicine that contains an opioid (narcotic). It is used to manage breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain. SUBSYS is prescribed when other pain treatments such as non-opioid pain medicines do not treat your pain well enough or you cannot tolerate them. SUBSYS is an opioid pain medicine that can put you at risk for overdose and death. Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to death.



Get emergency help right away if you take too much SUBSYS (overdose).  When you first start taking SUBSYS, when your dose is changed, or if you take too much (overdose), serious or life-threatening breathing problems that can lead to death may occur.

Taking SUBSYS with other opioid medicines, that may make you sleepy, such as other pain medicines, antidepressants, sleeping pills, antianxiety medicines, antihistamines, or tranquilizers, or with alcohol or street drugs can cause severe drowsiness, confusion, breathing problems, coma, and death.

Never give anyone else your SUBSYS.  They could die from taking it.  Store SUBSYS away from children and in a safe place to prevent stealing or abuse. 

Selling or giving away SUBSYS is against the law.

If you stop taking your around-the-clock opioid pain medicine for your cancer pain, you must stop using SUBSYS.  You may no longer be opioid tolerant.  Talk to a healthcare provider about how to treat your pain.

Because of the risk for misuse, abuse, addiction, and overdose, SUBSYS is available only through a program called the Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) Access program. To receive SUBSYS, you must:

o Talk to your healthcare provider

o Understand the benefits and risks of SUBSYS.

o Agree to all of the instructions.

o Sign the Patient-Prescriber Agreement form.

For more information about the TIRF REMS ACCESS program, go to or call 1-866-822-1483.

SUBSYS is only available at pharmacies that are part of the TIRF REMS Access program. Your healthcare provider will let you know the pharmacy closest to your home where you can have your SUBSYS prescription filled.

Be very careful about taking other medicines that may make you sleepy, such as other pain medicines, antidepressants, sleeping pills, antianxiety medicines, antihistamines, or tranquilizers.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

SUBSYS can cause life-threatening breathing problems which can lead to death.

Do not take SUBSYS if:

  • You are not opioid tolerant. Opioid tolerant means that you are already taking other opioid pain medicines around-the-clock for your cancer pain, and your body is used to these medicines.
  • You have severe asthma, trouble breathing, or other lung problems.
  • You have a bowel blockage or have narrowing of the stomach or intestines.
  • A short-term pain that you would expect to go away in a few days, such as:
    • Pain after surgery
    • Headache or migraine
    • Dental pain
  • You have an allergy to any of the ingredients in SUBSYS (fentanyl, dehydrated alcohol 63.6%, purified water, propylene glycol, xylitol, and L-menthol).

Before using SUBSYS, tell your healthcare provider if you have a history of:

  • Troubled breathing or lung problems such as asthma, wheezing, or shortness of breath
  • Head injury, seizures
  • Liver, kidney, thyroid problems
  • Problems urinating
  • Pancreas or gallbladder problems
  • Abuse of street or prescription drugs, alcohol addiction
  • Mental problems including major depression, schizophrenia or hallucinations (seeing or hearing things that are not there)
  • Slow heart rate or other heart problems
  • Low blood pressure

Tell your healthcare provider if you are:

  • Pregnant or planning to become pregnant. Prolonged use of SUBSYS during pregnancy can cause withdrawal symptoms in your newborn baby that could be life-threatening if not recognized and treated.
  • Breastfeeding. SUBSYS passes into breast milk and may harm your baby.
  • Taking prescription or over-the-counter medicines, vitamins, or herbal supplements. Taking SUBSYS with certain other medicines can cause serious side effects that could lead to death.

Do not take any medicine while using SUBSYS until you have talked to your healthcare provider. Your healthcare provider will tell you if it is safe to take other medicines while you are using SUBSYS.

Be very careful about taking other medicines that may make you sleepy, such as other pain medicines, antidepressants, sleeping pills, antianxiety medicines, antihistamines, muscle relaxants, or tranquilizers.

When taking SUBSYS:

  • Do not change your dose. Take SUBSYS exactly as prescribed by your healthcare provider. See detailed “Instructions for Use” for information about how to take SUBSYS.
  • Use SUBSYS exactly as prescribed by your health care provider. Do not use more than 2 doses of SUBSYS for each episode of breakthrough cancer pain. You must wait four hours before treating a new episode of breakthrough pain with SUBSYS.
  • Your healthcare provider will prescribe a starting dose of SUBSYS that may be different than other fentanyl containing medicines you may have been taking.
  • Call your healthcare provider if the dose you are taking does not control your pain.
  • Do not stop taking SUBSYS without talking to your healthcare provider.
  • After you stop taking SUBSYS, see the “Instructions for Use” section at the end of the Mediation Guide for information about the right way to dispose of SUBSYS when no longer needed.

Do not drive, operate heavy machinery, or do other dangerous activities until you and your healthcare provider know how SUBSYS affects you. SUBSYS can make you sleepy, dizzy, or lightheaded.

Do not drink alcohol or use prescription or over-the-counter medicines that contain alcohol while using SUBSYS. Using products containing alcohol during treatment with SUBSYS may cause you to overdose and die.

Do not switch from SUBSYS to other medicines that contain fentanyl without talking with your healthcare provider. The amount of fentanyl in a dose of SUBSYS is not the same as the amount of fentanyl in other medicines that contain fentanyl.

Possible side effects of SUBSYS:

Breathing problems that can become life-threatening

Get emergency medical help if you have:

Trouble breathing, shortness of breath, fast heartbeat, chest pain, swelling of your face, tongue, or throat, extreme drowsiness, light-headedness when changing positions, feeling faint, agitation, high body temperature, trouble walking, stiff muscles, or mental changes such as confusion

These symptoms can be a sign that you have used too much SUBSYS or the dose is too high for you. These symptoms may lead to serious problems or death if not treated right away.  If you have any of these symptoms, do not use any more SUBSYS until you have talked to your healthcare provider.

The most common side effects of SUBSYS are: 

  • constipation, nausea, sleepiness, vomiting, tiredness, headache, dizziness, abdominal pain, weakness, anxiety, depression, rash, trouble sleeping, low red blood cell count, swelling of the arms, hands, legs and feet. Call your healthcare provider if you have any of these symptoms and they are severe.
  • Decreased blood pressure. This can make you feel dizzy or lightheaded if you get up too fast from sitting or lying down.

These are not all the possible side effects of SUBSYS.

Call your doctor for medical advice about side effects.  You may report side effects to the FDA at 1-800-FDA-1088.  For more information, go to