Health Insurance and Epilepsy

Lack of affordable health care is one of our nation’s gravest problems. Health insurance policies are expensive, especially for people with preexisting conditions such as epilepsy. Although people with epilepsy have always had trouble obtaining affordable health care, the problem is growing. One cost-cutting tactic employed by many health insurance providers is to limit coverage for certain conditions such as epilepsy.

People with epilepsy who are fortunate enough to have health insurance may find that certain diagnostic procedures and treatments are not covered. For example, some plans do not cover expensive outpatient tests such as ambulatory electroencephalograms (EEGs) and magnetic resonance images (MRIs). Other policies deny coverage for specialized inpatient services such as video-EEG monitoring. Sometimes the resistance of insurers can be overcome if both the patient and the doctor persist in documenting the need for specialized services. The process of getting approval for these specialized services is often unduly prolonged, however, and sometimes coverage is ultimately denied. Please check with your insurance plans to verify the type of coverage you have.

Antiepileptic drugs are also expensive, but there are several ways to cut their costs:

• When applying for health insurance, check to see if there is a prescription plan and, if so, how the plan works. It may be useful to compare the possible increased costs of a health care plan that includes partial or complete coverage for medications to the costs of drugs.
• Shop around before purchasing medication. There may be considerable differences in the price of prescriptions between pharmacies in the same town.
• Ask your doctor about generics
• Find out whether Medicare Prescription Drug Coverage can benefit you
• Check if you are eligible for drug assistance programs in your state
• Check with the pharmaceutical companies for their prescription assistance programs. Most major manufacturers of brand-name antiepileptic drugs offer programs to make drugs available to patients with limited incomes.

Some useful resources for prescription assistance are listed below:

Free Medicine Program
Established by volunteers, the Free Medicine Program helps patients substantially reduce or completely eliminate their prescription drug costs.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

RxAssist
A nonprofit group that provides information to health care providers to help patients get medications.

Rxhope.com
A patient assistance company partially funded by the pharmaceutical manufacturers. It promises to speed requests for no-cost medications. The website includes information on which medicines are covered by assistance programs.