Generic Drugs

[lhenchak]

My 14-year-old son has been on Keppra for nearly 2 years (seizure free). Now that a generic form has come out, our insurance will only pay for the meds if we switch him to generic. I think this is absolutely crazy to switch him and risk a breakthrough seizure. It is so hard to find a med that works, and now that we have, we are told that we have to try the generic form, and then if he has a seizure on it, we can go back. The doctor says that generic is only required to have 80% to 120% of the active ingredient, which would mean that if his particular generic is only 80%, he would have an increased risk of seizures. He is afraid to switch because he feels like his seizures are barely under control, and they are the grand-mal type.

Any suggestions for how to get the insurance to continue to cover the brand-name Keppra that has controlled his seizures for 2 years instead of us being forced to take a risk with the generic?

[Bernard]

Hi lhenchak, welcome to the forum.

I'm guessing you would need your neurologist to intervene and tell them it was medically necessary.

[lhenchak]

Hi! Thanks!

The neurologist said that she could only get the insurance company to approve the brand name as being mandatory if we first tried the generic. Then if he has a seizure, we can request to go back, but that just seems like an awful risk to be forced to take, since we know the brand-name Keppra works. It seems like the insurance company has the upper hand in dictating to us what we must try.

[skillefer]

As far as I know, if your doctor states on the prescription "No Generics, Fill as Written" then the pharmacy will have to fill it that way. Some states have other specific terms, but that's the gist of what needs to be written on the prescription. Also, your doctor's office can contact the insurance and ask for an override because the Brand name prescription is medically required.

[lhenchak]

Hey Bernard!

Also, I forgot to mention that there is a big debate about this going on and I know people are fighting to try to get this changed, as it is standard to require people to try the generic brands of all drugs in order to save costs. However, they have found that a large number of people on anti-seizure medications end up having to go back to the brand name for control of their seizures, and it is being said that the risk for switching someone who has seizure control on their current medication is too high of a risk - loss of job or driving privileges if a seizure occurs because the generic doesn't work or even death from the breakthrough seizure itself. It's one thing to force people to try generics for high blood pressure and such and it is quite different to switch seizure control medications, as it cannot be monitored, only after a breakthrough seizure or death occurs does one know that it didn't work. Anyway, while they are fighting this out and until it is changed, I didn't know if someone else had found a way to get the insurance company to cover it. I thought about writing a letter and requesting them to state that they would take full financial responsibility for any death or disability that might occur to my son due to this switch if he should have a seizure because of it after full seizure control for so long. I don't know. I just thought I'd throw it out there and see if anyone had any ideas.

[dfwtexas]

Boy, I can relate...these insurance companies have us over a barrell and they know it. It is so frustrating that they risk your health to save themselves a few dollars. My insurance company actually wanted me to have my arm amputated rather than pay for a doctor that knew how to save it.
I agree that you are going to have to have your dr take on the insurance company. By the way, I am on Keppra and having good results and then in Dec they switched me to generic. The generic caused terrible migraines and my doctor contacted insurance company and said I had to have Keppra, not generic.
Good luck!

[lhenchak]

Thanks for the thoughts. It's like the insurance companies have become our new doctors and can tell the doctors what they can prescribe. It's not right. I've read about a number of people who had a return of seizures because of a switch to generic, and it's just so wrong to make someone switch when they're on something that's working, but the doc says that the insurance company says that we can't know if it will work until we try, so we have to try it before they will allow us to switch back. I hope that by trying it, he doesn't have a seizure. Right now, I'm paying $300 a month for the brand name, because I'm not yet willing to risk it, but I don't know how long I can afford that.

[lhenchak]

That is true that they do have to fill it as written but the insurance doesn't have to pay it. The problem is that generics are only required to contain between 80% and 120% consistently to be considered equal. Some generics will contain 80% and some will contain more near the 120%. If a person with seizures gets the generic that has been provided through a company that is "meeting the standard" with only 80% of the effective ingredient, that could cause a seizure. In my son's case, he take three 500-mg tablets twice a day. If he gets the standard generic 80% level, he would only get 400 mg in each tablet, or 2400 mg instead of 3000 mg daily.....that is not good and not worth the risk.

[brain]

Welcome to CWE, but while what you are
implying is true; however - they can beat
the system by going on "override". *grins*

Medically Necessary and "Override".

Half of my feedbag (anti-epileptic drugs) is
on override (brand name) and the other
half is generic. Moreover, it is required that
it has to be worked out via the Doctor's
Office - must be deemed as Medically
Necessary and go on Override.

If they (Insurance) refuses to comply;
you can sometimes even turn to the Pharma
themselves and they can assist you if they
have a program available, to keep you on
that brand name. Laws and Regulations
fluctuate from State to State and from
Insurance to Insurance.

[Bonito1947]

Hi, this is Bonito1947, and was simply reviewing the various messages on this epilepsy website as I just signed up today. I take 5200 mg of generic keppra, 300 mg zonisamide, and 200mg of generic lamictal. I have had a seizure disorder for 42 years taking various kinds of meds. No doubt, keppra is better than the generic, but the generic does work. But there in One Thing all Neurologists Can DO!!! That is, They can obtain samples from the drug providers, and you have a right to ask all of the neurologists in your provider area. When I did not have medicare, my neurologist provided me samples for three ears, and I was on depakote, dialantin, etc. I have had all types of grand mals, petit mals, absent seizures. Later, Bonito1947