Did you know that, in most states, your insurer can change the original terms of your prescription coverage at any time and force you off of a medication, even one you may have been taking for years? Fortunately, five states —Connecticut, New York, New Jersey, Florida, and Washington — have introduced bills this session to prohibit this controversial insurance practice, commonly known as non-medical switching. More states are expected to do the same, and the U.S. Pain Foundation is actively participating in or leading efforts to support each of these bills.
The type of insurance coverage changes that lead to non-medical switching include increasing a co-pay for a medication, moving a medication to a costlier tier, or removing coverage for a medication entirely. When these coverage changes force patients off their clinician-prescribed medication onto an insurer-preferred medication—regardless of the health impact — it is known as non-medical switching. Typically, clinicians aren’t made aware of the forced switch, and patients usually have little recourse to appeal it. Unfortunately, the new medication might not be as effective as the old one or may cause an adverse reaction. Studies show that switching medications for financial reasons, not medical ones, can lead to increased symptoms, side effects, and even relapse. As a result, non-medical switching may actually increase overall health care costs in the long run. For these reasons, U.S. Pain is one of many health advocacy organizations that oppose non-medical switching.
“This practice is not only unsafe and potentially more expensive, it’s unfair,” says Emily Lemiska, associate director of state advocacy for U.S. Pain. “Insurers are making these coverage reductions in the middle of the year, after open enrollment, when patients are locked into the plan. Essentially, patients are being sold one set of benefits, only to find the benefits they receive may differ.”
To help better understand the impact of non-medical switching, U.S. Pain is asking its members—patients, caregivers, and clinicians— to take a survey on the issue. The patient and caregiver portion of the survey requires 15 minutes; the caregiver section only takes five minutes.
“We need data and stories to help educate policymakers on why non-medical switching is so harmful,” adds Shaina Smith, director of state advocacy and alliance development. “Hard evidence and real-life stories about the negative impact are essential to successfully passing these bills into law and better protecting patients.”
To take the survey, click here.