Anti-seizure drugs (also known as anticonvulsants) are the most popular and cost-effective treatment for controlling and/or lowering seizures in the majority of patients with epilepsy. However, there is no “one-size-fits-all” treatment for epilepsy, as pharmaceutical response varies depending on seizure type and individual. Unfortunately, one’s ability to control seizures and lead a semi-normal lifestyle does not come cheaply.

A new study published in an online issue of Neurology, the medical journal of the American Academy of Neurology, has discovered that the cost of brand-name drugs that can control seizures, almost tripled from 2010 to 2018, rising 277 percent during that time. Brand name drugs make up 79 percent of epilepsy drug costs even though they only made up 14 percent of pills.

“People with epilepsy experience challenges accessing their medications across the drug supply chain—from high costs as evidenced by the recent studies, to practices like step therapy and prior authorization, to some anti-seizure medications being deemed controlled substances. The cost of brand anti-seizure medications increasing is troubling, as there is no one-size-fits-all treatment for people with epilepsy and people need affordable and timely access to the most effective treatment(s). The consequences for people with epilepsy are too high—as delayed or impeded access to the most effective treatment increases the likelihood of breakthrough seizures and related consequences including injury, disability or even death,” the Epilepsy Foundation’s Chief Medical & Innovation Officer, Dr. Jacqueline French, who was not involved in this study, told ZME Science.

Some patients with epilepsy find it difficult to afford the anti-seizure medications prescribed by their doctor. Despite the fact that the Affordable Care Act established an overall out-of-pocket limit for most types of insurance, deductibles and limits can be quite expensive. There is no out-of-pocket limit under Medicare, so both Medicare and commercial insurance recipients struggle to pay for their prescriptions.

“The costs for brand-name antiseizure medications have consistently increased since 2010, particularly boosted by increased prescriptions for the drug lacosamide in addition to a steep increase in the cost per pill, with brand-name drugs costing 10 times more than their generic counterparts,” said study author Samuel Waller Terman of the University of Michigan, and a member of the American Academy of Neurology. “Previous studies have shown that drugs are the most expensive part of neurologic care, and antiseizure drugs were the second-highest category of costs among drugs prescribed by neurologists.”

Researchers examined the records of a random sample of 20 percent of Medicare users who had coverage between 2008 and 2018. They found that brand-name pharmaceuticals cost increased from $2,800 per year in 2008 to $10,700 per year in 2018, but the cost of generic drugs dropped from $800 to $460 per year during that time. An increase in the number of prescriptions for the medicine lacosamide accounted for 45 percent of the entire increase in brand-name expenses.

Over time, brand-name medications made up a lower percentage of pills, falling from 56% in 2008 to 14% in 2018. According to Terman, the drop in brand-name medicine prescriptions over time is most likely due to the rising availability of generic alternatives. He noted that the patent for lacosamide will expire in March 2022, as well as other changes, will have an impact on prescribing trends.

“Doctors should consider the societal cost when judging whether the increased expense of brand-name drugs is worth the possible benefits,” Terman said. “While newer generation drugs have potential advantages such as limited drug interactions and different side effect profiles, there have been conflicting studies on whether they are cost-effective.”

Doctors must personalize drug choices to the patient, and there is no one-size-fits-all solution. Many epilepsy medications might cause interactions with other medications as well as side effects like cognitive issues.

The study discovered that between 2008 to 2018, the use of first-generation epilepsy medicines, as well as enzyme-inducing treatments with numerous drug interactions, dropped.

Epilepsy affects almost 50 million individuals worldwide, making it one of the most common neurological diseases. Mortality rates among people with the debilitating condition are three times the rate of the general population and sudden death rates are more than twenty times higher. From 1999 to 2017, epilepsy mortality rates in the United States increased by 98.8% while all-cause mortality declined by 16.4%.

Because only Medicare prescription claims were included in the study, the findings may not apply to a younger population with private insurance. The study received no direct funding.