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. We found that there are many AEDs which are not on the Medicaid formularies, which can affect access to care, require prior authorization (PA). Eligibility for Medicaid benefits varies widely among the states. All states must meet federal minimum requirements and have the option to expand Medicaid beyond the minimum federal guidelines under the ACA. In 2015, 31/50 states chose to expand their Medicaid services. Numerous studies indicate improvement across a broad range of measures regarding access to care as well as utilization of medications and services in states that expanded Medicaid under ACA provisions. Some studies have demonstrated that the improvement in access to care and utilization has led to an increase in diagnoses of certain chronic conditions and an increase in the number of adults receiving consistent care for chronic conditions. Our study explored the impact of ACA on Medicaid coverage of AEDs across. Methods: Information was collected from online Medicaid databases for 47 states and the District of Columbia (DC). AED formulary information for each of the 47 states and the DC was reviewed. Information regarding expansion of benefits under the ACA was collected from online sources. State Medicaid formularies were categorized as inclusive, exclusive or restricted based on the extent of coverage of available AEDs. Formularies were then reviewed and assessed with regards to expansion status under ACA. Results: Data reviewed from the 47 states and DC demonstrated that there are differences among states in the availability of AEDs in relationship to whether PAs are required or not. State Medicaid formularies for 14 generic AEDs and 22 brand AEDs were reviewed. Medicaid AED formularies for 3 states (Hawaii, Nevada and Texas) were categorized as inclusive, since a majority of the AEDs were covered. Texas is one of the 19 states that did not expand Medicaid under the ACA. Indiana and Colorado were the only states categorized as restricted since its AEDs were characterized as Non-Formulary. Both states, did expand their Medicaid services and coverage under the ACA. California chose to expand its Medicaid services under the ACA and was categorized as exclusive, since certain newer AED brand formulations of certain older AEDs were characterized as non-formulary and required a PA. Conclusions: There are many AEDs which are not on the state Medicaid formularies and require PA, resulting in invariable delays for patients receiving AEDs for management of epilepsy. Medicaid expansion under the ACA has had an inconsistent impact on formulary status of AEDs for patients with epilepsy. Funding: None