Have you ever been forced to switch medication by your insurance company? Switching patient medications for financial reasons instead of medical ones is a trend among insurers in the United States. Many commercial health plans have begun switching stable patients onto cheaper medications in an attempt to lower company costs. This is driven by a desire to lower their bottom-line expenses, and can often frustrate, harm, and worsen medical outcomes for healthcare consumers.
What is non-medical switching?
At its core, non-medical switching is simply forcing patients to change treatments or medications for a reason that is not related to their health; this reason is often driven by changes in health plan policies. There are few ways in which non-medical switching takes place:
- The list of approved drugs for a particular condition or disease is changed by a patient’s healthcare plan,
- Prescribers and/or pharmacists are incentivized to switch a patient’s medication,
- Co-pay coupons for patients (needed to afford certain medications) are either severely limited or eliminated entirely,
- Out-of-pocket requirements for patients are increased, or
- The maximum coverage for certain prescription medications is reduced.
Common sense would suggest that changing a patient’s treatment without medical cause might not have positive effects. Thanks to recent research from the Institute for Patient Access (IfPA), this theory is borne out in the results. Three main findings were noted after IfPA examined four years of data from the Commercial Claims and Encounters and Medicare Supplemental database. First, even though non-medical switching is almost entirely motivated by a desire for cost reduction, patients who change treatment without cause can actually cost more in non-drug expenses for companies in the future. Second, the lowest average per-member monthly spending was for patients that did not switch medications. Third, switching represents a disruption in patient care and is linked to making subsequent switches in the future. Patients who underwent more than one switch were also linked to higher average non-drug expenses.Ultimately, IfPA’s findings resulted in two major policy implications:
- Changing patients to a cheaper medication does not necessarily reduce overall expenses. Non-drug expenses go up for patients who non-medically switch.
- Switching impacts overall patient care and overall expenses. The initial switch pushes patients on a path towards multiple switches and an increase in healthcare costs down the road.
How non-medical switching hurts patients with diabetes
Formulary changes and non-medical switching may have special implications for patients with diabetes. Insulin and oral diabetes medications that are similar may still create very different responses among patients. For example, a drug may share a common FDA categorization, but vary in its dose, method of administration, or instructions. All these things can change patient experiences, including new or increasing side effects.
Additionally, if patients are driven to change health plans due to a new design implementation, they may have to begin their search for an appropriate dose and medicine regimen from scratch. If not fully stabilized, this can create a risk for hypoglycemic events. Such a danger is seemingly unnecessary; if patients are stable on their current regimen, the risk that comes with non-medical switching and pushing patients to new plans is unwarranted. The insidious and unexpected costs of non-medical switching can be seen in patients with diabetes as well. Time, energy and financial burden are all factors that patients must deal with when attempting to find a new regimen. Lab work, medication, and doctor’s visits are expensive and may result in even further switching or complications to treatment. Ultimately, although non-medical switching provides up-front cost savings for healthcare companies, it can cost patients both short- and long-term, as well as creating higher non-drug costs for the companies themselves. The Alliance for Patient Access sums up the problem: “Non-medical switching may provide cost savings for health plans… but they extend no such promise to patients with diabetes, who could instead receive a one-size-fits-all treatment regimen fueled by health plans’ financial considerations rather than personal health needs.”
Some states are taking action
If you live in New York, ____________________________, you can write a letter to your state legislators and ask them to support legislation that limits or bans non-medical switching!