Non-Medical Switching and Diabetes

Non-medical switching disrupts patient care, increases out-of-pocket costs, and often has negative consequences such as: new symptoms and side effects, increased frustration, and harmful medication reactions. Additionally, this also often does not result in any cost savings for the patient or insurer, but instead causes an increase in doctor’s visits, hospitalizations and ER visits in many states. 

"Non-Medical switching is like playing Roulette with patient’s lives. Medications are not “one size fits all." My son, diagnosed with type 1 diabetes, had a severe reaction to the insulin our insurance switched him to. This is an unsafe practice and needs to stop!"

Non-medical switching simply doesn’t make any sense either financially or morally. Financially, it may save the insurer money in the very short term, but only by moving costs onto patients when they have to pay for additional doctor visits and other services to switch to the new drug or device. And morally, it’s not right for an insurance company to interfere in the decisions a patient makes with their healthcare team. Treatment decisions are not made lightly, and when patients and their healthcare teams aren’t listened to, we don’t get the care we deserve. Diabetes management varies greatly from person to person, so treating patients like we’re all the same simply does not work.

For patients with diabetes, a change in medication can result in unmanageable fluctuations in insulin, increased out-of-pocket costs, and additional visits to their physician. The infographic below displays an example of a patient’s frustrations.

What is Non-Medical Switching?

As a way to increase profits, health insurers have been restricting formularies, and imposing benefit changes- often at the expense of the patient. For patients with chronic conditions, like diabetes, this means an abrupt change in their treatment plan can occur and disrupt their medical stability. For patients with diabetes, this treatment plan was typically hard won, and unique to them. A seemingly ‘simple’ change in formulary can cause life-threatening alterations to the insulin levels of a patient with diabetes.

However, an insurer may opt in to non-medical switching, sacrificing a patient’s well-being, and abandon a successful therapy for one that costs their health plan less. Health plans can execute non-medical switching in a multitude of ways, including eliminating the drug from their formularies, or adding additional out-of-pocket costs to the patient via changing the drug’s coverage tier.

A recent study completed by the Alliance for Patient Access (AfPA) states:

Nearly 40 percent of patients (38%) reported that the new medicine was not as effective as the previous one, with more than one in 10 saying it “didn’t work at all.”

Failure to Communicate

In the occurrence of non-medical switching, patients often find themselves uninformed. 48% of patients state that they found out about the change to their prescription when at the pharmacy where they went to pick up their medication(s). This causes a decreased ability for proper disease management; patients are potentially unaware of possible drug interactions, new side effects, and are at risk for the emergence of previously relieved symptoms. In fact, AfPA found that 74% of non-medical switches occurred without the patient’s health care provider knowing. In fact, recent research shows that these unbeknownst changes can disrupt a patient’s health care to an extreme- resulting in them ‘giving up’ and deciding to stop taking their medication completely.

For diabetes, where individual treatment is key to disease management, eliminating options can cause a dangerous limitation to patient treatment. When a patient is faced with losing access to their life-stabilizing treatments, they lose the ability to control their condition, causing new symptoms and side effects. This then leads to an increase in lab testing, hospitalizations, physician visits, and, for diabetics, a higher chance of DKA. Determining the proper treatment plan is often long and frustrating. A patient from the recent AfPA study states “It literally had taken us, my doctor and I, years up to that point to find the right medicine that worked for my issues, and I was on it barely a year before insurance decided to take it away from me.” 

Placing restrictions on non-medical switching can protect patient health and add value to the patient-physician relationship.

Watch the short video below to learn more about how non-medical switching impacts diabetes.

Thankfully, states have become increasingly aware of the issue, resulting in recent laws being passed in Illinois, and Maine- with more to come! Until then, however, many are forced to fight for their medications- or use those that are not right for them or their families. 

"For my daughter, one type of rapid acting insulin simply does not match her well. It causes atrophy quickly. We’ve known this for years. But now thanks to non-medical switching, she can ONLY get that kind of insulin that does not work well with her. It’s infuriating. Her doctors know and agree with her. Her CDE does too. But some person at a desk made a deal and so she must try to live with the type that does not work well for her."

Moira McCarthy- DPAC Champion Tweet

Become an Advocate

Interested in advocating against non-medical switching in your state? Click here to learn more about becoming an advocate!

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