Illinois is taking steps to limit insurance companies from forcing patients to switch doctors and medications based on cost.
H.B. 4146 prevents insurance plans from making you switch doctors mid-contract year. It amends the Managed Care Reform and Patient Rights Act to ensure that insurance companies cover the doctors they say they cover when you choose and buy a plan. This bill has passed both houses and is awaiting the governor’s signature to become law.
H.B. 2694 also amends the Managed Care Reform and Patient Rights Act. It would prohibit a health care plan from ceasing to cover a prescription drug during a contract year if a patient is stable on their medication. On May 31, 2018, H.B. 2694 was sent to the House Rules Committee a second time. The synopsis of the bill says:
the health care plan shall
not modify an enrollee's coverage of a drug during the plan year if the
drug has been previously approved for coverage by the plan for a medical
condition, the plan's prescribing provider continues to prescribe the drug
for the medical condition, and the patient continues to be an enrollee of
the health care plan.“
Non-medical switching negatively impacts patients by disrupting their care and does not generate cost savings for the patient or the insurer.
A recent NIH study found that patients who had been switched off their preferred medication had more doctor office visits, experienced new or worse medication side effects, and had problems with their new prescriptions not working. This issue is further complicated for people with diabetes because insulins on the market are not identical. When a patient is switched from one insulin to another, the patient’s dosing and administration requirements change. DPAC has done several posts on non-medical switching. You can read DPAC’s statement, read a patient’s view on non-medical switching, and read a guest blog by Christopher G. Parkin.