Prior authorization is the process that many health insurance companies use to determine if they will cover a prescribed service or medication. This process can often prevent or delay access to the particular treatment option that a physician feels is the most appropriate for an individual.
There is no “one size fits all” treatment option for epilepsy, and the response to epilepsy medications can be different for each person. Maintaining seizure control with minimal side effects requires careful evaluation and monitoring by the physician and patient. To change, limit, or deny access to medications could be extremely dangerous. People with epilepsy who experience a delay in accessing their medication, or have their medications switched, due to onerous prior authorization requirements, are at higher risk for developing breakthrough seizures and related complications. Restricting access to physician-directed care also significantly increases medical costs related to preventable seizures, along with lost wages and productivity, not just for the individuals living with epilepsy but also their families and communities.
The Epilepsy Foundation supports the creation of a standardized prior authorization process, including a form that can be submitted electronically and a requirement that insurance companies respond quickly to all prior authorization requests.