Access to Care

The Epilepsy Foundation actively advocates at the state and federal level for public policies that improve access to quality care for people living with epilepsy. Timely access to appropriate care and effective coverage for epilepsy medications is a critical concern for people living with epilepsy, because epilepsy medications are the most common and most cost effective treatment for controlling and/or reducing seizures.

Individuals living with epilepsy who experience a delay in accessing their medication due to prior authorization and step therapy requirements, high cost-sharing, medication substitutions without physician and patient consent, and onerous drug monitoring requirements, are at a high risk for developing breakthrough seizures and related complications, including Sudden Unexpected Death in Epilepsy (SUDEP). 

Access to Care in the States 

Medicaid

The Epilepsy Foundation strongly supports preserving open access to epilepsy medication in state Medicaid programs. Epilepsy medications are not interchangeable, and individuals often react quite differently to available treatments so they need meaningful access to the full range of treatments available—and the specialists who know how to prescribe them.

Medicare

The Epilepsy Foundation strongly supports Medicare Part D’s Six Protected Classes policy which ensures greater protections for six classes of medications, including anticonvulsants for epilepsy. Medications in the six protected drug classes are not interchangeable, and individuals often react quite differently to available treatments so they need meaningful access to the full range of treatments available—and the specialists who know how to prescribe them.

 

ACA Marketplace 

The Epilepsy Foundation supports eliminating barriers to care in the plans offered by the Marketplace created by the Patient Protection and Affordable Care Act (ACA). As a leader of the I Am (Still) Essential coalition, made up of more than 300 national and state patient and community groups, we focus limited benefits; high cost-sharing; and lack of transparency and uniformity in plans offered in the Marketplaces created by the ACA.

 

Medical Cannabis

 

Reviewed on May 2016

Access to Care Advocacy CHIP letter