New York is taking steps to limit insurance companies from forcing patients to switch medications based on cost.
S. 5022 and A. 2317 would prohibit a health care plan from making prescription drug formulary changes during a contract year. S. 5022 was introduced in March 2017 and A. 2317 was introduced in January 2017. Currently, the A. 2317 has passed the Assembly and is waiting for S. 5022 to catch up. S. 5022 is in the Committee on Insurance. The sponsor memo for the bill says:
Section 1 creates a new section 4909 of the Insurance Law to state that a health care plan which provides essential health benefits under the federal affordable care act may not remove a prescription drug from a formulary during the enrollment year. If the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the enrollment year. The plan may also not add new or additional formulary restrictions during the enrollment year. A health care plan may move a prescription drug to a tier with a larger copayment, coinsurance and different deductible if an AB-rated generic equivalent drug is added to the formulary at the same time.
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.