New York Patients Are Being Forced Off Prescribed Medications During the Plan Year, Providing A Need for New Legislation to Fix the Problem

Business Wire

Global Healthy Living Foundation survey finds nearly all respondents (98.2%) support legislation prohibiting insurance companies from financially pressuring them to switch from their prescribed medication

UPPER NYACK, N.Y.--(BUSINESS WIRE)-- On behalf of a group of 36 patient and provider groups, today Global Healthy Living Foundation (GHLF) released results of a survey showing that a majority of those in New York living with chronic health conditions have experienced “non-medical switching”—insurance coverage reductions which pressure patients to switch their prescription medications. Reductions in coverage include increased out-of-pocket costs, eliminating a drug from the formulary entirely or other restrictions around access. The survey, conducted by GHLF, found that consumers are being hurt by insurer and pharmacy benefit manager (PBM) initiated switches and support state-level action on the issue. Patient advocates in New York have been calling for the passage of S5022-C/A2317-C sponsored by Senator Serino and Assemblywoman Peoples-Stokes since 2015. The bill will establish consumer safeguards to ensure that New Yorkers have access to lifesaving and life-enhancing therapies through consistent coverage, stable formularies, and fair out-of-pocket costs.

"What many people in New York may not realize is that despite signing a contract, their insurance company may alter the terms by reducing their drug coverage at any time during the plan year," stated Seth Ginsberg, president and co-founder of the New York based GHLF. “Insurance companies are playing “bait and switch” with their customers, which in this case is dangerous because a person’s health can be put at risk when access to their medication becomes uncertain. It’s time for our New York legislators to protect patients from non-medical switching.”

While consumer fairness is a main concern, patients and providers argue non-medical switching is harmful to patient health and undermines providers’ efforts to do what’s best for their patients. The survey found that nearly two-thirds (65 percent) of New York residents with chronic illness had to switch to a different mediation than what was prescribed due to a change in coverage. Further, more than two out of three patients (69 percent) experienced changes in coverage that caused their primary therapy to become suddenly and significantly more expensive. The vast majority of respondents (86 percent) reported now paying more out-of-pocket for their prescribed medication, with 60 percent reporting to pay a lot more.

Medication Switching Disrupts Care and Leads to Negative Health Consequences

54% of respondents had to try multiple medications before finding another medication that worked for them.
72% reported that their new medication, after being switched, worked somewhat or much worse than the original prescribed medication
51% experienced side effects after switching to a new medication
93% of those who experienced side effects reported that they were worse compared to previous side effects, with 50% saying they were much worse
35% reported seeing their healthcare provider or going to the emergency room due to complications following a switch to a new medication and 10% reported being hospitalized.

“We believe that as New Yorkers, we deserve the medical coverage that we chose and that our access to vital treatments should be protected in order for us to lead the most productive lives possible," said Kathleen Arntsen, President and CEO of Lupus and Allied Diseases Association. “We urge our lawmakers to stand with us by ensuring ethical accountability from insurers in requiring them to honor their contracts and not alter the terms mid-plan year so that treatment decisions remain focused on personalized patient care, and not solely on cost.”

Beyond the health and cost implications, the survey found one third (33 percent) of all respondents reported never receiving 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. Instead, more than half (52 percent) learned of changes from their pharmacist, and a small percentage (8 percent) was informed by their physician.

Organizations supporting non-medical switching legislation in New York include GHLF, Lupus and Allied Diseases Association, New York State Rheumatology Society, American Cancer Society, Cancer Action Network, Coalition of State Rheumatology Organizations, Arthritis Foundation, Alliance for Patient Access, Aimed Alliance, American Liver Foundation, Latino Commission on AIDS, Hispanic Health Network, Mental Health Association in New York State, NAMI New York State, National Association for the Advancement of Colored People (NAACP), MS Society, Susan G. Komen, Medical Society State of New York, New York State Osteopathic Society, New York Chapter American College of Physicians, Center for Independence of the Disabled (CIDNY), New Yorkers for Accessible Health Care, Epilepsy Foundation of NENY, Northeast Kidney Foundation, American Diabetes Association, American Lung Association, ConsumersUnion, Pharmacist Society of the State of NY (PSSNY), US Pain Foundation, Institute for Community Living (ICL, Inc.), Crohn’s & Colitis Foundation, American Association of Retired Persons (AARP), National Psoriasis Foundation, American College of Rheumatology (ACR), Patients Rising Now, National Patient Advocate Foundation, and National Infusion Center.

An executive summary and infographic detailing additional survey results is available on the GHLF website at https://creakyjoints.org/advocacy/new-york-patient-sentiment-toward-non-medical-drug-switching/. The advocacy groups plan to continue their outreach efforts to educate patients, providers and lawmakers on the harmful impact of non-medical switching.

About the Survey

In February and March 2018, GHLF partnered with 36 patient and provider advocacy groups, which collectively represent hundreds of thousands of New York residents living with chronic illness and their care providers. GHLF and these groups invited New York residents living with a chronic or rare illness to complete an online, 36-item survey that investigated patient experiences with the manipulation of their respective health plans’ formularies.

A diverse sample of 219 New York residents diagnosed with chronic or rare diseases completed the survey (of 510 that started the survey). Although respondents’ individual diseases varied widely, five separate classes were represented: mental health (18 percent), autoimmune (32 percent), neurological (11 percent), oncological (18 percent), and other (34 percent). Most participants had either private insurance (46 percent) or public insurance (48 percent), and the rest had “other” forms (5 percent). More of the participants were unemployed (54 percent) and about one-third (34 percent) were either employed full-time, part-time, or self-employed. The majority of participants (53 percent) reported having a household income of $50,000 or less per year.

About Global Healthy Living Foundation

The Global Healthy Living Foundation is a 501(c)(3) non-profit organization whose mission is to improve the quality of life for people living with chronic illnesses, such as arthritis, osteoporosis, migraine, diabetes, psoriasis, and cardiovascular disease by advocating for improved access to care at the community, state, and federal levels, and amplifying education and awareness efforts within its social media framework. GHLF is also a staunch advocate for vaccines. The Global Healthy Living Foundation is the parent organization of CreakyJoints, the go-to source for millions of arthritis patients and their families world-wide who are seeking education, support, advocacy and patient-centered research through ArthritisPower, the first ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Visit www.ghlf.org for more information.