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Rajesh Pahwa, MD: Underutilization of Levodopa-Carbidopa Intestinal Gel

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The director of the Parkinson’s Foundation Center for Excellence at the University of Kansas Medical Center shared the reasons why LCIG is underused in clinical care.

Do you feel as though that this gel is being underutilized and and what are some of the barriers to implementing this into more common uh clinical care without doubt it is very underutilized okay and and the reason being uh if people don’t understand what’s the difference between a pill and a pump and if you only think about oh it is giving it more continuously

You are missing half the story because half the story is that your pill is not even getting to the small intestine in a timely fashion to be absorbed and i didn’t even talk about if a person takes a fatty meal that’s going to even slow down the gastric emptying you know if you had high protein that’s going to slow down the absorption so there are other situations

That we didn’t even talk about from that part so yes it is underutilized and there are multiple reasons why you know if a patient is otherwise doing relatively well they don’t want a tube getting into your stomach because mentally it still feels like you know your picture of a person having a feeding tube is that advanced patient either bedridden or wheelchair

Bound and and you are otherwise doing well during your good times and you’re like i’m not at that stage or i don’t want a tube hanging out of my my belly the other thing is the pump i mean the pump is still decent size uh once you add the uh the cassette for levodopa i mean it’s like a soft uh you know novel book kind of a thing so again that’s another reason

People say oh that’s a huge pump uh even though it’s not huge in their mind it is still big enough that they don’t want to carry it and and the other thing is people think they cannot do certain things uh like exercising and all which they can do perfectly but again it’s the mindset that people have but to me that is part of the big under utilization in the

Pump is the surgical part where a tube is put in and then you have a tube hanging out which which people feel like oh suddenly it’s not that bad on the other side people are fine doing deep brain stimulation where they’re actually having brain surgery so that part i’ve never been able to quite figure out where a person is willing to have brain surgery rather

Than you know abdominal surgery and and the final reason is you know the the approval process is completely different deep brain stimulation being a surgical process medicare you know it’s approved surgery kind of a thing now when it comes to medication it’s a whole different path which medicare looks at and same thing with private insurances so it’s not like

Okay the patient has all these criteria and it is done it is the surgery is fine but for the medication you have to get pre-approval you have to keep getting approval so that’s a huge setback that is there and then what if a patient ends up in a nursing home once they get in the nursing home they are paid on a fixed amount you know you have a medicare patient

You are paid whatever x number of dollars a day so now when you have this expensive medication you subtract x minus y and they cannot afford to have a medicare patient have a pump in the nursing home or even in rehab centers and all where they are paid per day that suddenly most of it goes towards the medicine so there are economic reasons to why in certain

Situations you cannot use it you

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Rajesh Pahwa, MD: Underutilization of Levodopa-Carbidopa Intestinal Gel By Neurology Live