Medicare and Medicaid spending on epilepsy medications more than doubled over 8 years, driven largely by third-generation and brand-name drugs, CMS data showed.

From 2012 to 2020, Medicare Part D spending on anti-seizure medications increased from $1.16 billion to $2.68 billion, while Medicaid spending increased from $973 million to $2.05 billion, reported Deepti Zutshi, MD, of Wayne State University in Detroit, in a presentation at the American Epilepsy Society annual meeting.

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“The rising price of anti-seizure medications far outweighs the rising number of claims in Medicare and Medicaid,” Zutshi told MedPage Today. “This is driven by the high costs of only a small percentage of anti-seizure medications, particular brand-name medications and third-generation medications.”

Third-generation anti-seizure drugs include lacosamide (Vimpat), perampanel (Fycompa), vigabatrin (Sabril), cenobamate (Xcopri), and brivaracetam (Briviact).

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While Medicare and Medicaid patients need to have access to these drugs, the cost to the system is significant and continues to rise, Zutshi observed. “The answer is not to remove access to the medications, but consider ways to cap or head off costs so we can continue to ensure the longevity of Medicare and Medicaid,” she noted.

Zutshi and colleagues used Medicare Part D and Medicaid datasets from 2012 to 2020 to evaluate drug spending. They analyzed anti-seizure medications by mechanism of action, drug generation, and brand versus generic. They excluded gabapentin and pregabalin from the analysis since those drugs are used for multiple other indications.

The number of Medicare Part D claims for anti-seizure medications rose from 19.2 million total claims in 2012 to 24.8 million claims in 2020. The total spent on third-generation anti-seizure medications was $124 million in 2012 and $1.08 billion in 2020. The total spent on brand-name drugs by Medicare Part D went from $546 million in 2012 to $1.62 billion in 2020.

Medicaid had 13.1 million total anti-seizure drug claims in 2012 and 18.7 million claims in 2020. Expenditures for third-generation drugs climbed from $147 million in 2012 to $1.15 billion in 2020. Medicaid spent a total of $605 million in 2012 on brand-name anti-seizure medications in 2012 and $1.46 billion in 2020.

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Other research has documented the costs associated with brand-name anti-seizure medications. Earlier this year, a retrospective analysis of Medicare beneficiaries showed that brand-name epilepsy drug prices rose by 277% from 2008 through 2018, while generic prices fell by 42% in the same period. Lacosamide contributed to 45% of the increase in brand-name anti-seizure medication costs in that analysis.

That study also showed that some generic epilepsy drugs cost about 10 times less than their brand-name counterparts. The cost of generic levetiracetam was $540 per year, for example, while brand-name levetiracetam (Keppra) was $6,900. Likewise, a 1-year supply of generic lamotrigine was $600, but a 1-year supply of brand-name lamotrigine (Lamictal) was $9,000.

“As more patients age into Medicare and with the possibility of rising individuals who qualify for Medicaid, there could be an astronomical increase in spending in anti-seizure medications that may not be sustainable,” Zutshi said. “Understanding these costs helps us to develop ways to counteract these costs with balancing the funding necessary to continue further drug development from pharmaceutical companies.”

“Pharmaceutical companies and government entities need to discuss ways to lower the cost of medications without restricting research and development,” she noted. “And healthcare providers should consider using generic medications more frequently and earlier than going straight to the brand-name medications, unless specifically required based on the mechanism of the seizures, concerns over side effects and drug interactions, or failure of response to the medication.”

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