SoonerCare could get refund if seizure drug doesn’t perform

Oklahoma’s Medicaid program will get some of its money back if an epilepsy drug doesn’t keep patients out of the hospital, the first time a state has reached such an agreement.

The agreement applies only to Fycompa, an anti-seizure drug the U.S. Food and Drug Administration approved in 2012 for certain types of epilepsy. Fycompa sells at an average retail price of $548, according to the prescription drug website GoodRx.com, though state Medicaid programs typically pay significantly less than the average customer.

Representatives for the Oklahoma Health Care Authority, which oversees SoonerCare, the state’s Medicaid program, declined to comment on how much it would get back if Fycompa doesn’t reduce hospitalizations of patients with epilepsy as much as promised. It also didn’t specify how much benefit Eisai Inc., the company that makes Fycompa, had promised.

Risks of using Fycompa include psychiatric problems such as aggressive behavior, thoughts of suicide, mood changes, memory trouble, irritability, hallucinations and delusions. It also can cause more common side effects such as dizziness, sleepiness, fever, face or leg swelling, rash, weight gain, shortness of breath and jaundice. It also carries a risk of addiction.

Ivan Cheung, the chairman and CEO of Eisai, said in a news release that he expects the drug to deliver.

“This value-based partnership with the Oklahoma Health Care Authority underscores our confidence in the value Fycompa can deliver as patients and their entire healthcare team strive together toward the ultimate goal of seizure freedom,” he said.

Nancy Nesser, pharmacy director at the health care authority, said she hopes the agreement will benefit patients while reducing spending on hospital stays.

“This agreement is yet another step toward building a responsive healthcare system for Oklahoma and delivering much-needed epilepsy treatment options to patients that benefit from our SoonerCare insurance programs,” she said in the news release.

Oklahoma is the first state to get permission from the federal Centers for Medicare and Medicaid Services to make payfor-performance agreements with drugmakers. Burl Beasley, assistant director of pharmacy services at the health care authority, said spending on high-price drugs has grown in recent years, with SoonerCare paying more than $500 million for prescriptions this year.

Beasley said he expects other states will watch to see if Oklahoma’s agreements save money. That’s not a sure bet, according to the Commonwealth Fund, because more patients could end up using pricey drugs, canceling out any savings or even increasing spending.