Abstracts

RATIONALE: Attempts to reduce the cost of health care lead to reductions in prescription plan benefits. These reductions are not recognized by patients or physicians until patients experience difficulties obtaining medication. Our study assessed the impact of these changes on seizure control and treatment choice. METHODS: We surveyed all patients in our pediatric and adult epilepsy clinics over 4 weeks. Questions included insurance status, medications, requirements and restrictions of prescription plans, and history of prescription plan problems. Sequelae of these problems were recorded included missed doses, increased seizures, ER care, or mandated medication changes RESULTS: 89 subjects completed the survey, 25 children, and 64 adults. In this group, 39 were disabled, 49 were dependent (25 children, 24 adults) and 9 adults were semi-independent, 12 were institutionalized. No problems were reported by 46. Problems were reported by 43. In 16 cases problems were minor, easily handled by pharmacist, physician or office staff. In 27 cases, significant problems occurred resulting in missed medications (10), increased seizures (6), ER visits (5/6) and hospitalization (2/5). Loss of coverage for a specific AED or a dramatic change in co-pay was reported by 5. Medication shortages were reported by 8 (6/8 subjects were receiving CBZ). Discontinuation or mandated changes in medication were identified by 5 subjects. Letters of medical necessity were required for 3 adults and 4 children. Four subjects enrolled in indigent programs to obtain AEDS. Only 14/89 subjects knew the actual cost of their medication. Pharmacy errors were reported by 2 subjects. Risk factors for major problems impacting medical care included the use of new AEDS and managed Medicaid/Medicare insurance CONCLUSIONS: Efforts to reduce health care costs lead to AED restrictions. Better communication on the part of insurers may avoid abrupt and unadvisable changes in AED therapy as well as permitting patients to remain on critical anti-epileptic medication.