The issue
Non
medical switching occurs when insurers reduce prescription coverage in a way that forces a patient to switch to a different treatment without any medical reason. Examples of coverage reductions include eliminating the drug from coverage; increasing the copay; or moving the drug to tier with more restrictions around access, like requiring prior authorization. These changes often take place in the middle of the plan year, outside of open enrollment, when the patient is already locked into the plan.
The problem
Patients and their clinicians may work closely together for years to find the right medication. When a patient is forced onto a new drug without any regard for their health or the knowledge of their clinician, it can mean unnecessary additional symptoms, side effects, and even relapse. These poor health outcomes can actually increase overall health care costs because of additional appointments, testing and imaging, trips to the emergency room, and/or hospitalization. The practice undermines clinicians’ expertise and makes it nearly impossible for patients to effectively compare plans and choose the right one for them.
Our position: Oppose
Nonmedical switching is bad for patients, the health care system and society at large and should not be allowed. If it does occur, it should be with the full knowledge and agreement of the clinician in consultation with the patient and there should be a standardized appeals process. Read our full position statement here.
Examples of U.S. Pain’s efforts
- New Illinois law protects families from insurance bait-and-switch
- Advocates rally in Connecticut and Illinois for patient safety
- Coalition applauds Florida bill to prevent medication interruptions
- U.S. Pain Advocacy Network revitalizes national coalition
- Continuity of care panel raises awareness in Pennsylvania
- “Don’t Switch Me” campaign launches
- Update on nonmedical switching efforts
- Nonmedical switching efforts continue
- Non-medical switching bills announced in three more states
- Illinois lawmakers announce bill to enhance consumer safety protections
- U.S. Pain Foundation applauds legislation to protect consumer from unfair reductions in prescription coverage
- TN Patient & Provider Groups Applaud Legislation to Protect Against Unfair & Unsafe Prescription Coverage Reductions
- Responses needed: take a survey on an unfair insurance tactic
Resources
- “The true costs of non-medical switching” – U.S. Pain (infographic)
- “Understanding non-medical switching” – Alliance for Patient Access (video)
- “Coverage Rights”– AIMED Alliance (appeal or file a complaint about an insurance problem)
- “Midyear Formulary Changes” — National Association of Insurance Commissioners (report)
Take action
- Take our nonmedical switching survey
- Find non-medical switching laws in your state
- Sign up to be a U.S. Pain advocate