Many patients with chronic and complex illnesses can stabilize their conditions and resume normal lives with the help of advanced medical therapies. But finding the right therapy often takes physicians and their patients through a painstaking process of trial and error, which can drag on for months or even years. For these patients, medical stability is hard won. Yet insurers sometime opt to sacrifice patients’ stability by imposing non-medical switching, compelling patients to abandon an effective therapy for a less costly alternative—for reasons unrelated to patients’ well-being.
Such switches take a variety of forms. Some insurers price patients out of their chosen medication by placing the therapies on specialty tiers that require burdensome cost-sharing. Other plans may simply eliminate coverage for certain medications.
Non-medical switching does not just ignore the process physicians and patients underwent to find a successful medical therapy. It also disregards the impact of switching medications arbitrarily. When patients lose access to the therapy that stabilizes their condition, they may also lose the ability to manage their disease, facing re-emerging symptoms and new side effects. Patients may require visits to the emergency room, additional appointments with their physician, lab tests and hospitalizations as a result—making the “less costly” alternative an expensive option for patients and insurers alike.
Equally problematic, patients who do regain access to their original medication may find that it has reduced efficacy. In some cases, the very act of switching can render the original medication less effective. With conditions for which few viable treatments exist, eliminating options can leave patients with dangerously limited alternatives.
Restricting non-medical switching can protect not only patient health but also the physician-patient relationship’s role in guiding patient care. Issue advocacy and education can raise awareness about the importance of patient access to approved medical therapies and galvanize support for legislation that limits such practices.
- Video: Diabetes Patients’ New Challenge, Diabetes Policy Collaborative, September 2018
- Fact Sheet: Protecting Patients from Non-Medical Switching, Keep My Rx, February 2017
- Blog: Fewer Treatment Choices and Higher Costs Plague Diabetes Patients, Institute for Patient Access, February 2017
- Health Care Analytics Brief: Cost-Motivated Treatment Changes: Implications for Non-Medical Switching, Institute for Patient Access, October 2016
- Infographic: Non-Medical Switching: Cutting Costs at the Expense of Patient Health, Alliance for Patient Access and Prescription Process, May 2016
- Infographic: Common Barriers to Treatment: Step Therapy, Non-Medical Switching & Pharmacist Substitution, Alliance for Patient Access and Prescription Process, April 2016
- “Keeping Stable Patients on Their Medications,” Coalition of State Rheumatology Organizations
Find out if there is proposed legislation in your state and take action.