A practical guide for providers on helping patients locate Trokendi XR. Includes 5 actionable steps, alternative strategies, and workflow tips for your practice.
When you prescribe Trokendi XR (Topiramate extended-release) for a patient with epilepsy or migraines, you expect them to be able to fill the prescription. But increasingly, patients are returning to your office or calling to report that their pharmacy doesn't carry it, can't order it, or has it on indefinite backorder.
This isn't a manufacturing issue or a formal FDA shortage. It's a market-driven availability gap caused by Trokendi XR's high cost, payer restrictions, and declining pharmacy stocking. As a prescriber, you're in a unique position to help patients navigate these barriers.
This guide provides a practical, step-by-step approach to helping your patients find Trokendi XR — and what to do when they can't.
Trokendi XR is still manufactured by Supernus Pharmaceuticals and is available through standard pharmaceutical distribution. The challenge is at the retail pharmacy level:
The medication has not been discontinued. When patients say they "can't find it," they're typically encountering stocking issues rather than true supply disruptions.
Understanding the root causes helps you set patient expectations and choose the right strategy:
At $1,200 to $1,400 per month retail, Trokendi XR represents a significant inventory investment for pharmacies. Unless a pharmacy has consistent demand — multiple patients filling monthly — they're unlikely to keep it on the shelf. The high cost per unit means even one unclaimed bottle represents a substantial financial risk.
Prior authorization requirements and step therapy policies have reduced the number of Trokendi XR prescriptions that reach the pharmacy. Many prescriptions are changed to generic Topiramate IR during the authorization process, further reducing pharmacy demand signals.
Generic Topiramate IR costs $10 to $30 per month. Even when a prescriber writes for Trokendi XR, pharmacists may discuss the generic option with patients, and many switch. This creates a self-reinforcing cycle of declining brand-name demand.
Before sending a Trokendi XR prescription to a pharmacy, use Medfinder for providers to check which pharmacies in your patient's area currently have it in stock. This simple step can prevent the frustrating cycle of rejected prescriptions and pharmacy callbacks.
Consider integrating this check into your prescribing workflow — it takes less than a minute and can save your staff significant time on phone calls.
When you identify a pharmacy with stock, send the prescription there directly. Recommend these pharmacy types to patients:
Providing patients with a specific pharmacy name and phone number — rather than telling them to "try other pharmacies" — dramatically improves the likelihood they'll fill the prescription.
Most payers require prior authorization for Trokendi XR. Proactively initiating the PA process at the time of prescribing reduces delays. Key documentation to include:
Having PA documentation ready before the prescription reaches the pharmacy prevents the common scenario where a patient arrives at the pharmacy only to learn coverage was denied.
Cost barriers are often the root cause of both patient access issues and pharmacy stocking decisions. Help eligible patients access:
When a patient has a reliable way to pay, pharmacies are more willing to stock and order the medication. For a comprehensive overview, see: Provider's guide to helping patients save on Trokendi XR.
Have a documented contingency plan in each patient's chart for what to do if Trokendi XR cannot be filled. This should include:
A pre-established backup plan prevents emergency situations where patients miss doses because they couldn't find the medication and didn't know what to do.
When Trokendi XR genuinely isn't accessible, these alternatives may be appropriate depending on the clinical scenario:
For the patient-facing version: Alternatives to Trokendi XR.
Here are some ways to build Trokendi XR management into your clinical workflow efficiently:
Prior authorizations for Trokendi XR typically need renewal every 6 to 12 months. Track these in your EHR or scheduling system to prevent coverage lapses that leave patients without medication.
Develop a simple protocol document for your practice that includes:
Assign one staff member (MA, nurse, or pharmacy liaison) as the point person for Trokendi XR access issues. This person can develop expertise in navigating PA processes, savings programs, and pharmacy relationships, making the process more efficient for the entire practice.
When initiating Trokendi XR, set patient expectations upfront:
Trokendi XR access issues are a byproduct of the broader dynamics in pharmaceutical pricing and payer management. While prescribers can't solve these systemic challenges, you can take practical steps to minimize the impact on your patients.
By verifying availability before prescribing, proactively managing prior authorizations, connecting patients with savings programs, and maintaining documented backup plans, you can ensure that your patients with epilepsy and migraines receive uninterrupted treatment.
Use Medfinder for providers to streamline pharmacy searches, and visit our related resources for more provider-focused guidance:
You focus on staying healthy. We'll handle the rest.
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