23-12-2009 | Generic substitution in epilepsy - an update

23 December 2009
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News has reached us of an important victory in the campaign against the substitution of branded epilepsy medications with generic equivalents.

The American Health Insurance company, Blue Cross Blue Shield (BCBS) have sent a letter to their members in the state of Iowa taking Topamax, Keppra and Lamictal, acknowledging that "users of brand name medications who switch to generic name medications... may experience epileptic events requiring medical care." 

As a result, they have revised their policy so that their members no longer have to pay the difference between brand name and the generic for the medications mentioned, all of which now have generic equivalents available.

When a drug comes off patent, any other pharmaceutical company can start making it. These versions are referred to as generics, while the original product is known as a branded drug. The price of generics is usually much less than that of a branded drug.

For almost all other conditions, replacing branded drugs with generic copies does not present a significant problem. However, in the case of epilepsy, statistics show that switching from a branded drug to a generic version or switching between different versions of generics can lead to the recurrence of seizures. It is therefore essential that people with epilepsy receive the same medication every time they have a prescription to ensure that their seizures are controlled to the maximum extent.

Brainwave has been very active in raising awareness of this issue in recent years, both among policy makers and among health professionals.

After BCBS's decision, The Epilepsy Foundation, the American equivalent of Brainwave will lobby other insurance companies and retail pharmacies to discontinue the practice in the US of using financial incentives to switch medications and to allow doctors and patients to choose the most appropriate treatment option.

Meanwhile in England, The Department of Health expects to implement generic substitution in 2010. A formal consultation process into generic substitution will begin very shortly and this will give epilepsy charities there an opportunity to influence final government policy.

In Ireland, both the Department of Health and the HSE support the increased use of generics where appropriate in order to save money on GMS expenditure. In general, the generic prescribing rate here is low compared to other EU states, and the overall expenditure on pharmaceuticals is higher. In order to implement cost-efficiencies in these difficult times, it is likely that the government will take further steps to increase the prescription rate of generics in the coming years.

Brainwave will continue to highlight the special case of epilepsy to policy makers and health professionals alike to ensure that the health and quality of life of people with epilepsy is protected. Epilepsy medications must be exempt from moves to drive increased substitution.

Note that Brainwave has no problem with the use of generic drugs for people with epilepsy who are newly diagnosed, provided that these AEDs are prescribed by an epilepsy specialist, are widely available and that the same generic is given each time. The problem arises when a person with epilepsy is switched from taking a brand to a generic or from one generic to another.

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