Cost Is a Barrier to Seizure Medication Adherence

For patients on chronic anticonvulsant therapy, cost is not just an inconvenience — it's a direct threat to adherence. When patients can't afford their Phenytoin XR, they skip doses, split tablets, or stop taking it altogether. The consequences — breakthrough seizures, emergency department visits, injuries — are predictable and preventable.

Phenytoin XR is one of the more affordable anticonvulsants on the market, but "affordable" is relative. For uninsured patients, those on high-deductible plans, or Medicare beneficiaries in the coverage gap, even a $40–$120 monthly out-of-pocket cost can be a burden.

This guide outlines practical strategies you can integrate into your clinical workflow to help patients access Phenytoin XR at the lowest possible cost.

What Your Patients Are Actually Paying

Understanding the cost landscape helps you have informed conversations:

• Generic Phenytoin ER with insurance — Most patients with commercial or Medicare coverage pay $0–$15 as a Tier 1 generic copay.
• Generic Phenytoin ER without insurance — Cash prices range from approximately $18 to $120 for a 30-day supply, depending on dose, quantity, and pharmacy.
• With a discount coupon — Prices drop to roughly $18–$45 for a 90-count supply of 100 mg capsules through platforms like GoodRx, SingleCare, or RxSaver.
• Brand-name Dilantin — Substantially more expensive. May require prior authorization from commercial plans and is not typically the cost-effective choice unless there's a clinical reason to use it.

The patients most likely to face cost barriers are those who are uninsured, underinsured, or in the Medicare Part D coverage gap. These are also often the patients least likely to volunteer this information unprompted.

Manufacturer Savings Programs

The landscape for manufacturer programs on Phenytoin XR is limited because the drug is overwhelmingly dispensed as a generic:

• No active manufacturer savings card for generic phenytoin — Since multiple generic manufacturers produce phenytoin ER capsules, there is no single manufacturer copay card program.
• Viatris (formerly Mylan/Pfizer Upjohn) — Viatris markets Dilantin Kapseals. Historically, savings programs existed through Pfizer, and Viatris may still offer limited patient support. Availability fluctuates, so it's worth checking if a specific patient needs brand-name Dilantin for clinical reasons.
• Viatris Patient Assistance Program — For qualifying uninsured patients, Viatris may cover Dilantin through their patient assistance program. Applications are available through the Viatris website.

In practice, because generic Phenytoin XR is so inexpensive relative to many other anticonvulsants, manufacturer programs are less relevant here than for newer brand-name medications.

Coupon and Discount Card Strategies

For uninsured patients or those with high copays, prescription discount cards can make a significant difference:

• GoodRx — Consistently shows competitive prices for generic phenytoin ER at major chains. Patients can access coupons via the app or website at no cost.
• SingleCare — Another free discount program accepted at most pharmacies.
• RxSaver, Optum Perks, BuzzRx — Additional options that may offer lower prices at specific pharmacies.
• Walmart $4 list — Phenytoin is included on some pharmacy generic discount programs. Patients should check directly, as formularies change.

A practical tip: encourage patients to compare prices across 2–3 discount platforms before filling. Price variation between pharmacies can be significant, even for the same generic drug.

For a comprehensive patient-facing resource, direct patients to our guide on how to save money on Phenytoin XR.

Patient Assistance Programs (PAPs)

For patients with financial hardship — particularly the uninsured — these resources can provide Phenytoin XR at no cost or very low cost:

• NeedyMeds (needymeds.org) — A comprehensive database of patient assistance programs, discount cards, and copay assistance. Covers both brand and generic medications.
• RxAssist (rxassist.org) — A similar resource with a searchable database of manufacturer and independent PAPs.
• RxHope (rxhope.com) — Helps patients apply directly to manufacturer programs.
• State pharmaceutical assistance programs (SPAPs) — Many states offer supplemental prescription assistance, particularly for Medicare beneficiaries. Eligibility varies by state.
• 340B pharmacies — If your practice or health system participates in the 340B Drug Pricing Program, patients may access medications at substantially reduced prices through affiliated pharmacies.

Consider designating a staff member — a medical assistant, nurse, or patient navigator — to help patients identify and apply for these programs. The application process is often the biggest barrier.

Generic Alternatives and Therapeutic Substitution

Phenytoin XR is already a generic medication, which limits further generic-based savings. However, there are several considerations:

Within Phenytoin Formulations

• Always prescribe generic phenytoin ER unless there's a specific clinical reason for brand-name Dilantin. Generic is substantially cheaper.
• Be cautious about manufacturer switching — Phenytoin has a narrow therapeutic index. While generic products are FDA-approved as bioequivalent, some patients may experience clinically meaningful differences when switching manufacturers. If a patient is stable, avoid unnecessary switches. If a switch is required (due to availability or cost), monitor levels closely.

Therapeutic Alternatives

If cost is a primary barrier and the patient is open to a medication change, consider:

• Carbamazepine (Tegretol) — Another affordable first-generation anticonvulsant for focal and tonic-clonic seizures. Also has a narrow therapeutic index and significant drug interactions.
• Levetiracetam (Keppra) — Generic is widely available and affordable. Fewer drug interactions, no blood level monitoring required. May be more cost-effective when factoring in monitoring costs.
• Lamotrigine (Lamictal) — Generic is affordable. Requires slow titration but generally well-tolerated with fewer drug interactions than Phenytoin XR.
• Valproic acid (Depakote) — Generic is affordable. Broad-spectrum efficacy but has its own monitoring requirements and teratogenicity concerns.

Any therapeutic switch should be made gradually and with appropriate monitoring, given the risks of breakthrough seizures. See our clinical guide on Phenytoin XR shortage management for prescribers for detailed switching protocols.

Building Cost Conversations into Your Workflow

The most impactful thing you can do is make cost a routine part of your clinical conversation. Here's how:

Screen for Cost Barriers

Ask directly: "Are you having any trouble affording your medications?" or "Has cost ever caused you to skip doses or not fill a prescription?" Studies consistently show patients underreport cost barriers unless asked.

Prescribe Strategically

• Specify generic on prescriptions. While most states allow automatic generic substitution, explicitly noting it avoids any confusion.
• Consider 90-day supplies — Often cheaper per-dose than 30-day fills, and reduces pharmacy visits.
• Use e-prescribing tools — Many EHR systems now display formulary information and real-time cost estimates. Use them.

Provide Resources Proactively

• Keep printed handouts for GoodRx, NeedyMeds, and Medfinder in exam rooms.
• Train front desk and MA staff to assist with PAP applications.
• For patients struggling to find Phenytoin XR in stock, direct them to Medfinder or review our provider guide on helping patients find Phenytoin XR.

Monitor and Follow Up

A patient who switches to a cheaper option or starts using a discount card should be followed up to ensure:

• They actually filled the prescription
• Blood levels remain therapeutic
• No new adherence barriers have emerged

Final Thoughts

Phenytoin XR is already one of the more affordable anticonvulsants, but affordability is patient-specific. An uninsured patient paying $80/month faces a very different calculus than an insured patient with a $5 copay.

By proactively addressing cost, connecting patients with discount programs and PAPs, and prescribing strategically, you can remove one of the most common — and most preventable — barriers to seizure medication adherence.

For more provider resources, visit Medfinder for Providers.