Nearly all respondents (98%) support legislation prohibiting insurance companies from financially pressuring them to switch from their prescribed medication
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"Although many consumers may not realize it, insurers presently are allowed to reduce drug coverage at any time during the plan year," stated
While consumer fairness is a main concern, patients and providers argue non-medical switching is harmful to patient health and undermines providers’ effort to do what’s best for their patients. The GHLF survey aimed to explore the prevalence and impact of non-medical switching. The survey found that nearly three out of five (58%) Tennesseans with chronic illness have had their insurance company make changes to their health plan’s formulary that reduced coverage of their prescribed medication. The reduction in coverage was so dramatic that the primary medication they were using to control the symptoms and progression of their disease became suddenly and significantly more expensive. In fact, more than two-thirds of the respondents (67%) were unable to afford the increase in out-of-pocket prices and were forced to switch to an entirely different medication.
Medication Switching Disrupts Care and Leads to
Non-medical switching resulted in a large majority of survey respondents (68%) trialing multiple medications before finding another drug that satisfactorily worked for them. Perhaps most important, the findings suggest that the practice of non-medical switching yields negative outcomes for the patient population, as an overwhelming majority (66%) of survey respondents reported that their new medication, after switching, was less effective. Nearly everyone (89%) experienced worse side effects compared to their previous medication.
“Patients and providers work for months, even years, to find a drug that stabilizes their health,” stated
Beyond the health and cost implications, the survey found almost half (44%) of all respondents never received notifications from their insurer (letters, emails or phone calls) detailing their plan’s midyear formulary changes or modifications being made to their health plan coverage.
The coalition is advocating to eliminate non-medical switching by private health plans. It includes GHLF, the
“We formed this coalition to demonstrate that both patients and health care professionals have real and urgent concerns about how easily insurance companies disrupt the treatment of people in Tennessee,” explained
An executive summary and infographic detailing additional survey results is available on the GHLF website at https://creakyjoints.org/tennessee-patient-sentiment-toward-non-medical-drug-switching/.
About the Survey
A diverse sample of 85
What is Non-Medical Switching?
Non-medical switching occurs when changes are made to a health plan’s formulary (the official list of available and approved medications) in a way that monetarily pressures patients to cease filling their prescribed medication in lieu of a “preferred” or cheaper drug. Insurers are free to change their formulary at will and often do so mid-plan year. Patients, however, cannot renegotiate their contracts until the end of their plan year. Essentially, patients are not being provided with the benefits that were marketed to them during the open enrollment period.
Non-medical switching can be very harmful to patients. As a result of being switched from their original, provider-prescribed medication, patients may experience additional side effects, symptoms, disease progression, and even relapse. Beyond the immeasurable impact of this unnecessary suffering, the negative effects of non-medical switching can result in additional medical appointments, emergency room visits and even hospitalization, thereby actually increasing overall healthcare utilization costs.