Analysis of anti-epileptic drugs in fee-for-service Wisconsin Medicaid

Off-label use of prescription drugs presents issues of patient safety and can significantly increase the overall prescription drug expenditure in providing health care services. As a class, the anti-epileptic drugs are provided for off-label use on a frequent basis. Because of the safety issues and increased cost with such prescribing practices, the Wisconsin Medicaid Drug Utilization Review Board (DUR board) reviewed the use of anti-epileptic agents in the fee-for-service Wisconsin Medicaid population.

Prescribers with the highest amount paid for drugs in this class, and for which there was no appropriate diagnosis (intervention group), were provided with a list of the patients for whom they prescribed the drug for an off-label clinical condition. A total of 488 prescribers were contacted and informed of the costs and hazards of off-label prescribing.

Using a comparison group of patients who were prescribed anti-epileptic agents but who did not reach the amount paid threshold (non-intervention group), the study demonstrated a decrease of 6652 prescriptions in the intervention group and an increase of 4194 in the non-intervention group. In addition, expenditures for the intervention group dropped by dollar 752,232 and the non-intervention group rose by dollar 835,351. It is estimated that the overall financial impact of this intervention was a savings of dollar 2,552,077 over the 5-month period of review.