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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.