Drug Formularies and the Availability of Antiepileptic Medications
In an effort to keep rapidly rising prescription costs down, it is becoming more common for health insurance plans, as well as state Medicaid programs, to develop drug formularies.
People with epilepsy are concerned about the availability of all antiepileptic drug options when enrolling in health care plans. This is due to the unique nature of epilepsy and differing response to anti-epileptic medications. Health insurance plans that use restrictive drug formularies to contain costs often make appropriate treatment inaccessible.
Drug formularies are intended to control or reduce expenditures for prescription drugs. The Foundation is committed to avoiding unnecessary medical expenditures. However, it important for individuals with epilepsy and seizure disorders to have access to all the available anti-epileptic medications through prescription drug formularies, including new as well as established formulations of both brand and generic products.
The Unique Nature of Epilepsy
Seizures and epilepsy develop in approximately 200,000 Americans of all ages each year. Overall, more than 3 million Americans have been diagnosed with epilepsy.
Not all people with epilepsy are the same. Due to the unique nature of epilepsy, a seizure may occur and affect different parts of the brain in very different ways. Anti-epileptic drug therapy is usually started when a patient has had more than one unprovoked seizure. Although one anti-epileptic drug product may prove to be highly effective with an individual, accurate prediction of an individual's response to medication is not possible.
As a result of new anti-epileptic drugs and other forms of treatment which have been developed in recent decades, the control of seizures has become an attainable goal for many people with epilepsy. However, a recent study has shown that over 1 million individuals continue to have persistent seizures even with treatment.
Drug formularies, with their inherent restrictions, may prevent individuals with epilepsy from following an optimal or prescribed drug therapy. A restrictive formulary does not take into account that medications for seizures are not interchangeable. The proper medication with the fewest side effects for one person is not the same as it is for another. In addition, switching of medications, e.g., from brand name to generic, from generic to generic, without a physician's oversight and monitoring can result in breakthrough seizures. The consequences of a breakthrough seizure can be far more devastating to an individual's health, worker productivity and to the cost of the illness to society than the recurrence of symptoms of other non-epilepsy related medical conditions.
Disclosure of Drug Formulary Information
The health and well-being of most individuals with epilepsy are dependent to a great extent on their anti-epileptic medications. The Foundation believes that drug formularies should include all anti-epileptic drugs, whether brand name or generic. In addition, the following drug formulary information should be disclosed to participants in all health plans: