Abstracts

RATIONALE: The cost of antiepileptic drugs (AED) can exceed $300/month. We assessed the impact of insurance and prescription plan restrictions on AED prescribing patterns and the ability of patients to cope with increasing drug cost.
METHODS: Our epilepsy clinic has developed programs to facilitate the insurance coverage of new AEDs for our patients. A standardized letter of medical necessity (LOMN) was developed to facilitate the use of AEDs not on formulary for regional HMOs. Pharmaceutical companies maintain programs to provide medications to the indigent patients. We employ a skilled worker to complete and submit the form. We assessed the impact of these programs on the availability of medications to our patients as well as the cost to our practice. We analyzed and compared the changes made in these programs over a 2 year period.
RESULTS: In the past year, changes in AED due to prescription plan restrictions has decreased from 5% to 1% with only one documented abrupt discontinuation of an AED (0.3%). In addition to our LOMN, 4 HMOs developed specific LOMN forms. Only one HMO made the LOMN form readily available to our clinic. In 2 of the 3 remaining HMO, the pharmaceutical sale staffs provided these forms. Overall, 10% of the patients required LOMN to obtain AED[scquote]s.
Enrollment in pharmaceutical sponsored indigent plans has increased by 250%. Up to 10% of our patients per month request these programs. In the past, patients requested these programs for AED[ssquote]s that they perceived as costly. Now, eligible patients request these programs for all AEDs. The average length of time to complete each form by a skilled worker is 45 minutes. Each form may be filled out 1-4 times/year. The estimated annual cost to the practice is $5,000 per year or one third of the annual revenue received from the group of patients enrolled in indigent programs. The average wait period for patients to receive these medications was 3 months (range 2.5-4 months). Some patients qualified for free medications on an ongoing basis while others received only 90 days supply.
CONCLUSIONS: Fewer patients in the past year were forced to change their medications because of formulary restrictions or cost. AED discontinuations due to insurance plan restrictions are less common. Patient attitudes regarding indigent programs may be shifting towards [dsquote]entitlement[dsquote], leading to more requests for these programs. Despite the limitations of pharmaceutical sponsored programs, even a 90 day supply of medications per annum was sufficient to permit these patients to continue expensive AED[scquote]s.
Disclosure: Honoraria - Mercedes Jacobson: Novartis, Cyberonics, GSK, Ortho-McNeil.