The Issue of Medication Switching

If you’re not having luck with one medication, you may be tempted to switch to a different medicine. Before making this choice, the EFEPA recommends that you discuss this decision with your physician to prevent any potentially life-threatening seziures. In fact, medication switching is often cited as a cause of seizures.

For years members of the epilepsy community have reported having seizures and other harmful side effects after switching from one version of an antiepileptic drug (AED) to another, whether the switch was brand-to-generic, generic-to-brand, or generic-to-generic. By law, the amount of medication delivered by one AED may differ from the amount delivered by another AED that the Food and Drug Administration (FDA) deems “equivalent,” and it may deliver the medication at a different rate.  There is growing evidence that these variations, however slight, can mean the difference between controlled epilepsy and breakthrough seizures or other negative consequences.

Download pdf of AED side effects and drug interactions

Patients today are most often switched from brand-name drugs to generics, or from one generic drug to another, for a single, non-clinical reason: pressure to reduce costs. In most states, unless a physician explicitly writes “dispense as written” or “no substitution,” pharmacists can switch a patient to a lower-cost generic drug without the consent or knowledge of either the patient or the physician.

Generic drugs are currently estimated to save consumers at least $8 to $10 billion a year at retail pharmacies because they cost less than the brand name versions of the same product. The Epilepsy Foundation actively supports the increased use of generic medications as a way to save money in healthcare. Because medications are a major cost of epilepsy, the availability of less expensive versions of brand name medicine can be very good news for people with epilepsy.

Medication switching is a big concern because seizures are serious and can have considerable cost to one’s health, well-being, and wallet– and can even be life threatening. As is being shown in related studies, the cost savings in the less expensive medications may be lost when overall health costs and results are taken into account for those patients who experience breakthrough seizures or troublesome side effects when switched from their usual seizure medicine.

The Epilepsy Foundation Eastern PA appreciates that cost-control is a worthy goal and, in general, it supports providing patients with greater access to generic medications.  The Foundation welcomes the opportunity that generic medications present to lower the overall costs of delivering effective healthcare to individuals and society.

But the we believe equally that short-sighted cost considerations should never be allowed to outweigh a patient’s health.  Indeed, if a patient is switched off of a well-functioning drug to avoid costs, the direct economic consequences on society if the cheaper drug fails—such as more ambulance rides and emergency-room visits, greater numbers of in-patient doctor visits, or lost worker-productivity—will quickly eliminate any short-term savings occasioned by the switch. Meanwhile, the negative impact on patients and their families can be immeasurable.

The Foundation has written to the major insurance companies sharing the data on switching and requesting that, given the elevated risk, companies not require patients on brand AEDs to switch and to eliminate any cost differential between brand and generic AEDs for people with epilepsy.

Medication Coverage and Prescription Assistance Programs

If you’re having trouble getting your medication covered by insurance, there are other options like Patient Assistance Programs. These are offered by different groups, including government organizations and pharmaceutical companies. If you need help figuring out what program is right for you, feel free to email us or give us a call. Click here for a downloadable list of Patient Assistance Programs.  Below is a brief overview of options.

  • PACE/PACENET—This is available to many of Pennsylvania’s senior citizens (65 years of age and older) through the Pennsylvania Department of Aging. It offers comprehensive prescription coverage to cover the cost of most prescription medications. The program requires no premiums or monthly fees. Contact PACE/PACENET at 1-800-225-7223 or
  • Pharmaceutical Company Patient Assistance Programs—Many pharmaceutical companies offer Patient Assistance Programs to those who cannot afford the cost of their medications but are ineligible for Medicaid due to their income. Following is a list of each company’s contact information:
  • Banzel—Eisai Neurology Patient Assistance Program 1-866-694-2550
  • Carbatrol—Shire Pharmaceuticals Carbatrol Patient Assistance Program 1-908-203-0657
  • Depakene—Abbott Patient Assistance 1-800-222-6885
  • Depakote, Depakote ER—Abbott Patient Assistance 1-800-222-6885
  • Diastat Acudial Rectal Gel—Valeant Pharmaceuticals International Patient Assistance Program 1-800-511-2120
  • Dilantin—Pfizer, Inc. (Connection to Care) 1-800-707-8990
  • Felbatol—Meda Pharmaceuticals Patient Assistance Program 1-800-678-4657
  • Gabitral—CephalonCares Foundation Patient Assistance Program 1-877-237-4881
  • HP Acthar Gel—Questcor Pharmaceuticals Acthar Gel Patient Assistance Program 1-888-435-2284
  • Lamictal, Lamictal XR—GlaxoSmithKline Bridges To Access 1-866-728-4368 *Advocate must pre-enroll patient
  • Lyrica—Pfizer, Inc. (Connection to Care) 1-800-707-8990
  • Mysoline—Valeant Pharmaceuticals International Patient Assistance Program 1-800-511-2120
  • Neurontin—Pfizer, Inc. (Connection to Care) 1-800-707-8990
  • Onfi — Lundbeck’s ONFI Support Center 1-855-345-6634 and visit for saving coupons
  • Phenobarbital—Xubex Patient Assistance Program 1-866-699-8239
  • Sabril—Lundbeck’s SHARE Call Center 1-888-45-SHARE (1-888-457-4273)
  • Tegretol, Tegretol XR—Novartis Patient Assistance Program 1-800-277-2254
  • Topamax—Janssen Ortho Patient Assistance Foundation 1-800-652-6227
  • Tranxene—Lundbeck’s SHARE 1-888-45-SHARE (1-888-457-4273)
  • Trileptal—Novartis Patient Assistance Program 1-800-277-2254
  • Vagus Nerve Stimulator—Cyberonics 1-800-332-1375 ext. 7493 or BJ Wilder Therapy Program
  • Vimpat—UCB Patient Assistance Program 1-866-395-8366
  • Zarontin—Pfizer, Inc. (Connection to Care) 1-800-707-8990
  • Needy Meds—This website provides information on patient assistance programs available for each medication. Go to
  • Express Scripts Specialty Distribution Services Rx Outreach Medications—This provides discounts for some generic medications. 1-800-769-3880
  • Xubex Pharmaceuticals Xubex Patient Assistance Program—This provides discounts for some generic medications. 1-866-699-8239 or
  • RX Hope—This website provides information on patient assistance programs available for each medication. Go to
  • PHRMA—This website provides information on patient assistance programs available for each medication. Go to
  • Together RX—This website provides information on patient assistance programs available for each medication. Go to
  • Veteran’s Affairs Veteran’s Benefits—This website provides information about benefits for veterans. Go to
  • Eli Lilly & Co—This website provides information about their patient assistance program and its eligibility requirements. Go to
  • Pennsylvania Rx Price Finder—This website allows for the comparison of costs per medication between pharmacies. Go to