Non-Medical Switching
What Is Non-Medical Switching?
Non-medical switching is a strategy that health insurers use to control costs and maximize profits by forcing stable patients to switch from their current effective medications to an insurer’s “preferred” drug. Insurers force patients to change medications for non-medical reasons, disregarding physician recommendation and patients’ individual needs.
Non-medical switching is a dangerous practice that devalues a provider’s medical expertise. NICA believes medical decisions should be made by providers with their patients, not by insurance companies.
Non-Medical Switching Legislative Map
When health insurers require patients to switch from an effective, prescribed medication for non-medical reasons, it can disrupt treatment, threaten disease stability, and create unnecessary administrative burdens for infusion providers and care teams. This legislative map was created to help infusion centers, nurses, and healthcare professionals understand the state laws that may apply, including restrictions on midyear formulary changes, continuity-of-care protections, and insurer notification requirements. Use this information to help patients maintain access to their prescribed treatments, identify when an insurer may be out of compliance, or take action when no state protections exist by contacting lawmakers to advocate for non-medical switching reform.
Click on a state to view applicable non-medical switching protections and requirements.
One thing to keep in mind: Some health plans — including many employer-sponsored plans — are regulated under federal law rather than state law. The plan administrator (often listed on the patient's insurance card or plan documents) can help determine which rules apply. Even where state protections exist, their scope may vary depending on the type of plan, medication, or coverage change. Providers and patients can advocate for stronger protections by contacting their state and federal lawmakers.
Non-Medical Switching Action Campaigns
Take action against non-medical switching by asking your elected officials to support legislation that regulates this practice.