Proposed legislation in Texas would have protected patients’ preexisting prescriptions year after year
WASHINGTON – The Institute for Patient Access (IfPA) released a new analysis of commercial health plan claims, “Cost-Motivated Treatment Changes & Non-Medical Switching.” Non-medical switching occurs when health plans, in an effort to cut their costs, drive stable patients to switch from their current medication to a less expensive alternative. In the analysis, IfPA discovered that some patients who switch to a less expensive prescription drug actually experience higher non-drug health care costs later on.
Current law in Texas requires health plans to protect patients’ preexisting prescriptions only within a current plan year. Non-medical switching legislation introduced in 2017 (H.B. 2882 and S.B. 1967) would have protected patients year after year within their current health plan. Given the new data, IfPA hopes the Texas Legislature will revisit the opportunity to strengthen patient protections against the practice of non-medical switching during the 2019 session.
Switching may also upset patients’ course of treatment; patients in eight disease states who switched prescription drugs once were more likely to switch again. Multiple switches also led to higher non-drug health care costs.
The analysis showed that continuity of care, however, keeps costs lower. Patients who did not switch medications experienced the lowest increase in non-drug health care spending.
Switching patients to cheaper prescription drugs seems like an obvious way to cut health care costs, and health plans employ this technique. But this new research suggests the long-term costs may outweigh the short-term benefits that health plans seek.
STATEMENT FROM AMANDA CONSCHAFTER, DIRECTOR, INSTITUTE FOR PATIENT ACCESS:
“Health plans have been operating under the impression that switching patients to less expensive medications is a surefire way to cut costs. As this data shows us, that may not be the case. Stable patients who experience non-medical switching go on to have higher non-drug health care expenses, generated by doctor’s appointments, lab tests, hospital stays or outpatient care. In short, in many instances it may cost less and be better for both patients and health plans to continue covering preexisting prescriptions for preexisting conditions.”
Non-medical switching can occur several different ways:
- when health plans change their formulary to eliminate certain drugs from coverage
- when health plans place medications on a tier that requires significantly higher out-of-pocket cost to the patient
- when health plans increase patients’ out-of-pocket requirements
- when health plans reduce the maximum plan coverage amount for prescription medications
IfPA examined a subset of 2011-2015 data from Truven’s MarketScan® Commercial Claims and Encounters and Medicare Supplemental database, which includes information for 3.9 million people. Research was conducted for IfPA by The Moran Company.
Austin American-Statesman: Commentary: Protect patients from nonmedical prescription switching
Houston Chronicle: Lawmakers take aim at insurance plan changes to patients’ medications