Practical Issues in Medicine
Most seizure medicines are expensive, the exceptions being the old-timers, such as phenobarbital and Dilantin. The newer seizure medicines can cost $300 per month. If a patient is on multiple medications, then cost accumulates to very high levels. The reason for these high prices is that invention of a new medication costs drug companies hundreds of millions of dollars. Most new medicines never make it to market. The companies charge enough on those that do to make their money back (and some profit as well).
Insurance companies may or may not pay for prescription medicines. Sometimes they pay a certain amount minus a co-pay of $5 - $35 per prescription. The insurers all have formularies that list their preferred medications. Medicines in the formulary are better covered by insurance than are medicines not in the formulary. Sometimes physicians can get individual permission to use a medicine for a particular patient, but this requires time and paperwork. Doctors usually do not know what insurance plans cover which medicines, because there are so many plans.
If your doctor has prescribed a medicine that is not on your plan, and therefore is beyond your ability to afford, ask your insurance representative what seizure medicines are covered. Then contact your doctor's office to see if any of these are reasonable alternatives. DO NOT take the approach of dropping the issue, since this could leave you without any medication.
Ordinary Medicare does not cover prescription drugs at all, a large political issue. Some of the HMO Medicare plans trade other benefits or increased cost for some prescription coverage. Medicaid (Medical in California) covers most of the seizure medicines, but needs a form called a "Treatment Authorization Request" (TAR) for approval of use of the newer medications. Your doctor's office may have some free samples, but only enough to get you started. Drug companies sometimes have compassionate use programs, with free medicines for patients who cannot afford them. Ask your doctor about these programs.
Generic medications are less expensive alternatives to brand name medicines. Generics become available when the brand-name patent expires. The advantage of generic medicines is the lower cost. The disadvantage is the uncertainty that it has been manufactured as well as has the original brand name medicine.
The value of generics is controversial. Generics usually are reliable, but generic seizure medicines are not as reliable as are the brand name medications. The main problem is how much medicine gets absorbed into your system. The FDA requires that bioavailability (the amount available to be absorbed into your body) of a generic drug be plus-or-minus 20% of the bioavailability of the brand name drug. Since pharmacies may stock different generic drugs each week, this could lead to a 40% fluctuation in serum levels of antiepileptic drugs, potentially enough to cause seizures or medication side effects.
If your seizures are infrequent and your payment plan mandates much higher cost for brand drugs, then generics are the best alternative. If you have uncontrolled seizures, then brand name seizure drugs are more reliable. Doctors can specify on a prescription that the brand name drug is required. However, the pharmacy then has the right to charge the patient the difference in cost between what the insurance company will pay and the cost of the brand drug. If the doctor does not specify "brand name," in most states the pharmacist can substitute a generic drug.