Work

Health care burden of access barriers to epilepsy care in the United States: A claims-based analysis of payer channels

Year: 2025

Type: article

Abstract: To describe access challenges, barriers to antiseizure medications (ASMs), and impact of ASM formulary policies for patients with epilepsy (PWE). Observational study of de-identified claims from an all-payer claims database (2014–2021) and a formulary/payer policy database. Adults prescribed ≥ 1 ASM following initial epilepsy diagnosis, with continuous medical/pharmacy benefits, were included. Demographic characteristics, proximity to/use of a neurology health care professional (HCP), health care resource utilization (HCRU), and costs were assessed. In total, 35,351, 33,339, and 24,722 PWE with commercial, Medicare, and Medicaid insurance, respectively, were included. The Medicare group was older, had a higher comorbidity index score, more males, and fewer non-White and Hispanic individuals versus other groups. Most (> 58 %) commercially-insured PWE had coverage to all six first-generation ASMs examined, six to 12 second-generation ASMs, and all four third-generation ASMs; coverage rates were higher for Medicaid while data for Medicare were incomplete. Most commercial and Medicaid PWE had no access requirements to first-generation ASMs; approximately two-thirds and half of patients had access requirements for second- and third-generation ASMs, respectively. Although > 90 % of PWE used a neurology HCP during follow-up, only about one-third lived within proximity. Of PWE with formulary data (N = 77,787), > 80 % and < 8.0 % were prescribed second- and third-generation ASMs, respectively. There were no clear patterns in epilepsy-related HCRU/cost. Data revealed difficulties in neurologist access and predominant use of second-generation ASMs, despite access restrictions for many PWE, suggesting obstacles in accessing treatment and specialist care. • More than 90 % of patients received specialist care over 12 months of follow-up. • Only about one-third of patients had an epilepsy neurologist close to home. • Access restrictions to 2nd/3rd generation antiseizure medication (ASM) were common. • Fewer than 8 % of patients used 3rd generation ASMs despite high formulary coverage. • Results suggest limited specialist access and a high burden of access restrictions.

Source: Epilepsy Research

DOI: 10.1016/j.eplepsyres.2025.107639

Authors: Herbert Peeples, Emily Achter, Christopher Dieyi, Keshia Maughn

Institution: STATinMED (United States)

Language: English

Topic: Epilepsy research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $2,880