Epilepsy Advocate Speaks on Importance of Medication Access

LANDOVER, MD – On Tuesday, September 30th the Epilepsy Foundation participated in two Congressional briefings organized by the Partnership for Part D Access to highlight the critical role Medicare’s six protected classes policy plays in ensuring meaningful access to physician directed care for the program’s most vulnerable beneficiaries. The six protected classes policy has enjoyed strong, bipartisan support since its inception in 2006 and has proven to be cost-effective while improving access to care for the most vulnerable and medically fragile Medicare beneficiaries.

The briefings featured patient perspectives from Carlton Zeigler, a Medicare beneficiary living with epilepsy, and Trudy Lapin, a Medicare beneficiary living with bipolar disorder. Carlton has battled epilepsy since he was a teenager and years of uncontrolled seizures and significant side-effects from epilepsy treatments eventually lead to disability. The six protected classes policy make it easier for Carlton to manage multiple conditions beyond epilepsy, although there are still a few access barriers even for medications in the protected classes.

“Living with poorly controlled seizures since I was 17 has led to an invisible disability that made it hard to stay employed and to multiple chronic conditions, like diabetes, that are the consequence of weight gain due to side-effects of epilepsy treatments,” said Zeigler. “I rely on Medicare to maintain access to my lifesaving medications and reduce my risk for sudden unexpected death in epilepsy (SUDEP).”

The panel was moderated by Chuck Ingoglia of the National Council for Behavioral Health and featured Dr. Nicole Brand, senior care pharmacist and professor at the University of Maryland; Dr. Ray Martins, chief medical officer of Whitman-Walker Health; Dr. Jeanie Tse, associate chief medical officer of the Institute for Community Living; Dr. Matthew Cooper, director of kidney and pancreas transplantation, MedStar Georgetown; and Dr. Joanne Buzaglo with the Research and Training Institute of the Cancer Support Community.

The Epilepsy Foundation strongly supports Medicare’s six protected classes policy and believes restricting access to necessary and appropriate medications is penny wise and pound foolish, leading to higher costs for the Medicare program. The House and Senate hearings are part of ongoing advocacy in response to a January proposed rule from the Centers for Medicare & Medicaid Services that would have changed the current policy that Medicare Part D plans must cover “all or substantially all” of six protected classes of medication. The proposed changes would have removed protected status for antidepressants and immunosuppressants in 2015 and antipsychotics in 2016. This would have been devastating for vulnerable patients—and costly to our health care system. Although anticonvulsants would have remained a protected class for now, the status of all protected classes, including antiretrovirals, antineoplastics and anticonvulsants, would have been eroded under the proposed criteria and the subjective nature of the way the criteria were applied. 

About Epilepsy 

When a person has two or more unprovoked seizures, they have epilepsy, which affects 2.8 million people in the United States and 65 million people worldwide. This year, another 150,000 people in our country will be diagnosed with epilepsy. Despite all available treatments, more than a third of people with epilepsy continue to experience uncontrolled seizures while many more experience less than optimal seizure control. 

About the Epilepsy Foundation 

The Epilepsy Foundation, a national non-profit with affiliated organizations throughout the United States, has led the fight against seizures since 1968. The Foundation is an unwavering ally for individuals and families impacted by epilepsy and seizures. The mission of the Epilepsy Foundation is to stop seizures and sudden unexpected death in epilepsy (SUDEP), find a cure and overcome the challenges created by epilepsy through efforts including education, advocacy and research to accelerate ideas into therapies. The Foundation works to ensure that people with seizures have the opportunity to live their lives to their fullest potential. For additional information, please visit www.epilepsy.com. 

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