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

2. 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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.