Impact of Prior Authorization of Antiepileptic Drugs in Children With Epilepsy

Elaine C Wirrell, Alexander J. Vanderwiel, Lauren Nickels, Saskia L. Vanderwiel, Katherine C Nickels

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: We assessed how commonly prior authorization results in treatment delay or missed doses in children with epilepsy. Methods: Parents of 462 children followed in a pediatric epilepsy clinic were surveyed regarding prior authorization in the preceding year. Epilepsy and insurance details were collected. If prior authorization was required, parents were asked whether it resulted in (1) delayed initiation of a newly-prescribed antiepileptic drug, and/or (2) lapse in coverage of a current medication. Prior authorization was defined as smooth if there was a less than seven day delay in starting a new antiepileptic drug and no lapse in coverage of a current medication. Results: A total of 164 families (35%) returned completed surveys. Mean age of the children was 11.2 (S.D. 5.3) years and 67.4% experienced seizures more than every three months despite trials of two or more antiepileptic drugs. Primary insurance was private in 82.9% and Medicaid in 15.2%. Prior authorization was required in 63 (38.4%) cases, and proceeded smoothly in only 31 (49.2%). Twenty-three children experienced a delay of seven days or more in starting a new drug, and 24 experienced a lapse in coverage of their current medication, 11 of whom missed doses. Of these 11, seven had increased seizures, and one required hospital admission for status epilepticus. Conclusions: Prior authorization of antiepileptic drugs is common but problematic, often resulting in either a delay of initiation of a new antiepileptic drug or a lapse in coverage of a currently-used antiepileptic drug, with a negative impact on seizure control.

Original languageEnglish (US)
JournalPediatric Neurology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Anticonvulsants
Epilepsy
Insurance
Seizures
Post-Traumatic Epilepsy
Parents
Status Epilepticus
Medicaid
Pediatrics
Pharmaceutical Preparations

Keywords

  • Antiepileptic drug
  • Children
  • Pediatric epilepsy
  • Prior authorization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Impact of Prior Authorization of Antiepileptic Drugs in Children With Epilepsy. / Wirrell, Elaine C; Vanderwiel, Alexander J.; Nickels, Lauren; Vanderwiel, Saskia L.; Nickels, Katherine C.

In: Pediatric Neurology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objective: We assessed how commonly prior authorization results in treatment delay or missed doses in children with epilepsy. Methods: Parents of 462 children followed in a pediatric epilepsy clinic were surveyed regarding prior authorization in the preceding year. Epilepsy and insurance details were collected. If prior authorization was required, parents were asked whether it resulted in (1) delayed initiation of a newly-prescribed antiepileptic drug, and/or (2) lapse in coverage of a current medication. Prior authorization was defined as smooth if there was a less than seven day delay in starting a new antiepileptic drug and no lapse in coverage of a current medication. Results: A total of 164 families (35{\%}) returned completed surveys. Mean age of the children was 11.2 (S.D. 5.3) years and 67.4{\%} experienced seizures more than every three months despite trials of two or more antiepileptic drugs. Primary insurance was private in 82.9{\%} and Medicaid in 15.2{\%}. Prior authorization was required in 63 (38.4{\%}) cases, and proceeded smoothly in only 31 (49.2{\%}). Twenty-three children experienced a delay of seven days or more in starting a new drug, and 24 experienced a lapse in coverage of their current medication, 11 of whom missed doses. Of these 11, seven had increased seizures, and one required hospital admission for status epilepticus. Conclusions: Prior authorization of antiepileptic drugs is common but problematic, often resulting in either a delay of initiation of a new antiepileptic drug or a lapse in coverage of a currently-used antiepileptic drug, with a negative impact on seizure control.",
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N2 - Objective: We assessed how commonly prior authorization results in treatment delay or missed doses in children with epilepsy. Methods: Parents of 462 children followed in a pediatric epilepsy clinic were surveyed regarding prior authorization in the preceding year. Epilepsy and insurance details were collected. If prior authorization was required, parents were asked whether it resulted in (1) delayed initiation of a newly-prescribed antiepileptic drug, and/or (2) lapse in coverage of a current medication. Prior authorization was defined as smooth if there was a less than seven day delay in starting a new antiepileptic drug and no lapse in coverage of a current medication. Results: A total of 164 families (35%) returned completed surveys. Mean age of the children was 11.2 (S.D. 5.3) years and 67.4% experienced seizures more than every three months despite trials of two or more antiepileptic drugs. Primary insurance was private in 82.9% and Medicaid in 15.2%. Prior authorization was required in 63 (38.4%) cases, and proceeded smoothly in only 31 (49.2%). Twenty-three children experienced a delay of seven days or more in starting a new drug, and 24 experienced a lapse in coverage of their current medication, 11 of whom missed doses. Of these 11, seven had increased seizures, and one required hospital admission for status epilepticus. Conclusions: Prior authorization of antiepileptic drugs is common but problematic, often resulting in either a delay of initiation of a new antiepileptic drug or a lapse in coverage of a currently-used antiepileptic drug, with a negative impact on seizure control.

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