NASHVILLE, Tenn. ― Medicare and Medicaid spending on antiseizure medications (ASMs) for people with epilepsy more than doubled in eight years, driven by costly third-generation and brand-name drugs, according to research being presented at the American Epilepsy Society Annual Meeting.
Brand-name drugs are significantly more costly than generic drugs. Many third-generation drugs remain under the brand name for 10 to 12 years before a less costly generic drug becomes available. Third-generation drugs are commonly prescribed because they typically are better tolerated than first- and second-generation drugs, including fewer side effects and less-serious interactions with other drugs. They also work in different ways to stop seizures, giving neurologists more options for treating patients with epilepsy.
“While it’s very important that Medicare and Medicaid patients have access to these drugs, the cost to the system is significant and continues to rise each year,” said Deepti Zutshi, M.D., lead author of the study and an associate professor of neurology at Wayne State University, Detroit. “The answer is not to remove access to the medications, but consider ways to cap or head off costs so we can continue to ensure the longevity of Medicare and Medicaid.”
Epilepsy affects nearly 3.4 million Americans, the majority of whom are older adults or children. In 2019, 1.1 million people with epilepsy received Medicare and 32.7% of patients 18 and older were covered by Medicaid in 2015.
Researchers analyzed data from the Medicare Part D and Medicaid Spending by Drug databases from 2012 to 2020. They found Medicare Part D spending on ASMs increased from $1.16 billion in 2012 to $2.68 billion in 2020. Medicaid spending on ASMs increased from $973 million in 2012 to $2.05 billion in 2020.
The number of claims increased over the eight years but at a much slower rate than costs. For example, while Medicare Part D claims increased by 29% during that time period, spending increased by 136%.
The much higher costs of the brand-name and third-generation drugs drove the overall increase, researchers noted. For example, for Medicare Part D, the total spent on third-generation ASMs was $124 million in 2012 and $1.08 billion in 2020, and for brand-name ASMs, the total spent increased nearly three-fold, from $546 billion in 2012 to $1.62 billion in 2020.
While drug development costs billions of dollars, the increase in costs over the years has far outpaced inflation, the researchers note. The solution to reducing the spending is complex, requiring a multifaceted approach, they noted.
“Pharmaceutical companies and government entities need to discuss ways to lower the cost of medications without restricting research and development,” said Dr. Zutshi. “And health care providers should consider using generic medications more frequently and earlier than going straight to the brand-name medications, unless specifically required based on the mechanism of the seizures, concerns over side effects and drug interactions, or failure of response to the medication.”