Abstracts

Rationale: Studies have shown that epilepsy patients are frequently part of a lower socioeconomic group and therefore have limited resources. As such, a significant number of patients with epilepsy in the United States rely on Medicaid for their medical and prescription drug coverage. Medicaid is regulated differently by each State, and each state's Medicaid formulary and dosing standard is potentially unique. Due to the large number of anti-epileptic drugs (AEDs) available, many AEDs may not be on the Medicaid formulary and require prior authorization before dispensation. This process of prior authorization can delay patients' access to AEDs and compromise therapy, which in the case of epilepsy can be dangerous and potentially life-threatening. Our purpose here was to identify the availability of AEDs in relationship to the requirement of prior authorization for Medicaid patients with epilepsy. Methods: We collected information from online Medicaid databases from ten states. We reviewed the AED formulary information for each State, which included Alabama, Alaska, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Kentucky, New York and Washington. The data collected included information on availability of generic and brand name AEDs in relationship to whether prior authorization was required or not. Approval processes for prior authorizations were also reviewed within each state. Results: Data from the eleven states reviewed demonstrated that there are differences among states in the availability of AEDs in relationship to whether prior authorizations are required or not. However, for the majority of states, generic formulations of AEDs were covered by Medicaid, while brand formulations of AEDs were not covered unless prior authorization was obtained. This includes all newer AEDs which are only available as the branded product and not available as generics. Prior authorizations required various steps for approval including verification of therapeutic failure or intolerance of a preferred AED and justification of use. Conclusions: There are many AEDs that are not on the Medicaid formulary and require prior authorization. Which AEDs are on the Medicaid formulary and which are not are state dependent. For those patients who are prescribed AEDs that are non-formulary and require prior authorization, there are likely invariable delays for that patient in receiving this needed AED therapy. This is an especially vulnerable population as patients that qualify for Medicaid generally have the fewest resources and are less educated about systems of healthcare. As such Medicaid patients are probably less capable of finding alternative methods to access their medications during this prior authorization period. Thus, Medicaid patients with epilepsy, especially those who have already failed those AEDs that are available as generic and are being prescribed newer AEDs, may have more lapses in their AED treatment than other populations and may be at increased risk for additional hospitalizations, status epilepticus, or even SUDEP. More research into this gap in care for Medicaid patients with epilepsy is needed. Funding: None