Continuity of Care in the Garden State Dr. Eric Geller State Policy Round Table Washington State Women in Government (WIG) 12, December 2016

About Dr. Eric Geller Neurologist in New Jersey Nationally Recognized Epileptologist Board Certified in Neurology and Clinical Neurophysiology Primary Specialties Neurology Neurophysiology-Clinical Epilepsy Executive Vice President of the Board of Directors for The Family Resource Network/Epilepsy Foundation of New Jersey Director, Adult Comprehensive Epilepsy Center, Saint Barnabas Institute of Neurology & Neurosurgery

About NEUROLOGY Neurology is a medical specialty with a focus on disorders of the nervous system. Some areas of specialty within Neurology include: Stroke Epilepsy Neuromuscular Sleep Medicine Pain Management Movement Disorders.

Neurology IN THE GARDEN STATE Patients with neurological conditions often work extensively with their health care providers to find the right medication for them. Neurological disorders, especially epilepsy, are precarious. Medications for neurological disorders are not often interchangeable. For example, medications for seizures don't have a lot of overlap. They generally do different things to the brain, have different side effect profiles, and interact with other conditions differently.

Threats to Continuity of Care IN THE GARDEN STATE However in New Jersey, many patients with neurological disorders, and those with other types of chronic health conditions, are currently at risk of losing access to the treatments that are keeping their health stable. Patients are being forced off their medications through a process known as non- medical switching. Insurers and PBMs force patients off of their medications through a variety of tactics including: Hiking out-of-pocket costs associated with certain drugs; Removing certain drugs from coverage altogether; and Placing restrictions around access to certain drugs. These benefit changes oftentimes occur mid-plan year when a patient must remain on their current plan.

THE EFFECTS OF Non-Medical Switching ON Chronic HEALTH CONDITIONS Those with chronic health conditions, such as neurological disorders, are dependent on their life-sustaining treatments to maintain the quality of life. Individuals with epilepsy depend on their medications to keep their health stable in order to retain their drivers licenses, and in many cases, their jobs. Any barrier to access to these treatments, including those instituted by their health care payers, risks these individuals health and very livelihoods.

Non-Medical Switching and negative health outcomes Therapy switches for non-medical reasons can result in adverse and potentially irreversible side effects. Oftentimes treatment switches are associated with health derailment, disease progression and devastating side effects. Epilepsy patients can experience breakthrough seizures as a result of treatment switches. These health outcomes often lead to a need for increased doctors visits, hospital visits, medical testing, and additional medications to control side effects.

PROVIDER EXPERIENCES WITH NON-MEDICAL SWITCHING Insurer-motivated medication switches neglect the process that patients undergo with their providers to find successful therapies with the least amount of side effects. A disparate amount of time and resources in provider offices is dedicated to appealing such insurer decisions out of medical necessity.