2023 American Academy of Neurology Abstract Website

Objective:

Examine provider access restrictions among adults with epilepsy enrolled under Medicaid.

Background:

Patients with epilepsy may not receive the antiseizure medications (ASMs) they need due to limited access to neurology healthcare professionals (HCPs).

Design/Methods:

Adults with ≥1 epilepsy diagnosis or ≥2 diagnoses for unspecified convulsions on different days (within 12 months) were identified in the all-payer claims database (January 1, 2014–May 31, 2021). Medicaid patients prescribed ≥1 ASM on/after initial diagnosis (date of first ASM prescription=index date) with continuous medical and pharmacy benefits for ≥12 months pre-and post-index date were included. Demographic characteristics at index and clinical characteristics within the 12-months pre-index were captured. Proximity to a neurology HCP for epilepsy-related care (defined as availability of a neurologist/neuropsychiatrist within the patient’s zip-3 location), and patient utilization of neurology HCPs during 12-months post-index were assessed.

Results:

24,722 patients (mean age 43.3 years; 62.4% female) met all selection criteria. Most patients were white (80.4%), non-Hispanic (67.7%), and resided in an urban area (91.1%). The most common comorbidities (≥20% of patients) were unspecified convulsions (48.9%), anxiety (34.5%), and depression (28.8%). Most patients were prescribed index ASMs by non-neurology HCPs; 25.0% received their index ASM prescription from a neurology HCP. Nationwide, 92.2% of patients (60.2% rural, 95.4% urban) utilized a neurology HCP to access ASM treatment during index or follow-up; however, only 28.7% (12.6% rural, 30.3% urban) lived within proximity of a neurology HCP.

Conclusions:

Most Medicaid patients with epilepsy had low access to neurology HCPs in proximity to home and were prescribed their first ASM by a non-neurology HCP. The majority of patients utilized neurology HCPs within 12 months of index, showing a high need for specialist care.