WHAT IS NON-MEDICAL SWITCHING?
Non-medical switching is a strategy that health insurers use to control their costs and maximize profits by forcing stable patients to switch from their current, effective medications to drugs that may not be as effective, for reasons unrelated to health. In other words, insurers force patients to change medications for non-medical reasons, disregarding physician recommendation and patients’ individual needs.
HOW DOES NON-MEDICAL SWITCHING OCCUR?
Eliminating coverage for certain medications
Increasing patients’ cost-share (e.g., copay or coinsurance)
Increasing patients’ out-of-pocket requirements
Reducing the plan’s maximum prescription medication coverage amount
To better understand the consequences of non-medical switching, imagine that you are traveling from New York to Los Angeles. After making all the necessary arrangements for your trip, you attempt to purchase airplane tickets for the appropriate time. In the middle of your transaction, your credit card company calls to inform you that instead of flying to California, they require you to travel by bus, because they get a better transaction rate from a particular bus company. This company doesn’t have a bus that travels directly from New York city to Los Angeles, but does have a bus that travels west, and may or may not end up in Los Angeles.
SAVING MONEY, BUT AT WHAT COST?
It can take years to find a treatment that works to successfully manage a complex condition. Forcing these stable plan enrollees to switch medications simply to save on cost can disrupt that carefully achieved equilibrium. Even the slightest variation in treatment protocol may trigger dangerous reactions, negative health outcomes, and ultimately negatively impact quality of life.
Additionally, when a patient switches off a medication and later switches back onto that same medication after failing other medication(s), that once effective treatment may lose its effectiveness due to increased tolerance.
Patients with complex chronic diseases, autoimmune diseases, and/or immunodeficiency diseases who were stable on a medication and then subsequently forced by their insurance provider to switch treatments may experience a disruption in the management of their condition, resulting in:
Resurgence of symptoms
Decreased quality of life
Non-medical switching supersedes doctors’ prescribing authority and forces stable patients to change medications in order to cut costs and maximize profits, regardless of the potential negative impact on patient health outcomes.
Patients must have access to a wide range of therapeutic options to find the right treatment protocol — the one that works. This is particularly important in the case of medications covered under the medical benefit, including intravenous immunoglobulin (IVIG) and biologic therapies for patients with primary immunodeficiency diseases and immune-mediated inflammatory conditions, like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, multiple sclerosis, psoriasis and lupus.
We believe that influencing the course of treatment for these patients constitutes the practice of medicine, which should be left in the hands of their physicians rather than insurance professionals.
In order to avoid increased clinical risk and keep stable patients healthy, state lawmakers must establish new legislation and enhance existing protections which will limit — and ultimately prevent — health plans from forcing patients to change medications for non-medical reasons during the plan year or re-enrollment period.