As Canada and Australia have similar demographics and national income levels, we sought to elucidate the similarity and differences in AED licensing and reimbursement between these countries, and the congruity of these decisions with current national and international guidelines. 

Since the 1950s, our pharmaceutical armamentarium for epilepsy treatment has expanded significantly. However, the use of newer anti-epileptic drugs (AEDs) is restricted on many national formularies despite better safety profiles. Furthermore, some of the newer AEDs are recommended as first line treatments for some epilepsy syndromes but not reimbursed accordingly. 

Licensing and reimbursement information in Australia was accessed via the Therapeutic Goods Administration (TGA) and Pharmaceutical Benefits Scheme (PBS). Canadian licensing information was accessed via the online DrugBank database. Reimbursement data was only available for the provinces of Alberta, British Columbia, and Ontario. We compared this information with the UK National Institute for Health and Clinical Excellence, Â鶹´«Ã½Ó³»­, and Ontario epilepsy guidelines.

There are similarities and differences between jurisdictions in terms of licensing and reimbursement. The licensing agencies relegate Lamotrigine and Levetiracetam to adjunctive treatments, despite better side effect profiles and guideline recommendations for first-line use. Reimbursement bodies in some Canadian provinces allow physicians to use their discretion in using these AEDs. Differences between jurisdictions occur mainly with newer AEDs. Some AEDs are licensed but not reimbursed, i.e. rufinamide. Some AEDs are only reimbursed in some provinces, yielding a postcode lottery in access in Canada. While many licensing and reimbursement decisions appear to be congruent with guidelines, others are not.

AED licensing and reimbursement in Canada and Australia have crucial similarities and differences. Some licensing and reimbursement decisions are incongruous with the most recent clinical guidelines. These decisions impact access to AEDs negatively in both countries.