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By Dharmesh Patel, MD

Every new COVID-19 variant reignites fears of untimely deaths. Yet heart disease continues to kill more people than the coronavirus every single year.  

It stands to reason then, that everyone, including insurance companies, would give their all to fight the ongoing epidemic of heart disease the way all hands have been on deck to fight coronavirus. But that’s not what I see. 

Instead, insurers play fast and loose with medications that prevent heart attack, stroke, pulmonary embolism and high cholesterol. They regularly swap around their formulary of approved drugs, dropping medications that are less profitable and changing which medications are “preferred.” 

The result? The very patients who need to lower their cardiovascular risk are getting switched from drug to drug like a dangerous game of musical chairs. To insurers, the distinction between one medicine and the next is measured only in dollars and cents. They see this practice, known as non-medical switching, as “no big deal.” They’re wrong. 

To understand why, let’s first take a closer look at the stakes.  

Cardiovascular disease is the number one killer of Americans. And, at a time when Americans want to lessen racial disparities, cardiovascular disease disproportionately impacts communities of color. Black Americans have the highest rate of death due to stroke. These are not patients whose medication you want to switch up willy nilly. 

Then there’s the impact of non-medical switching.  

Switching can be disruptive for patients after years of hard-won progress. Finding the right medication or combination of medications at the right doses can take months of trial and error. When patients are switched, they can lose ground on managing their disease. 

Switching can also cause dangerous gaps in treatment. Patients may delay picking up their new medication at the pharmacy, for example, or skip doses if they experience side effects from a new medication.  

Finally, non-medical switching is dismissive of the trust and decision-making that happens between patients and their providers. Cardiologists and patients work diligently to find a treatment that will yield optimal results. Outside interference undermines that relationship and can leave patients confused, frustrated and angry. 

America desperately needs to get a handle on the cardiovascular health crisis. That requires insurers and policymakers alike to face certain realities and do something. One action that’s already underway is the Safe Step Act of 2021, House Resolution 2279. The act ensures that patients who are already stable on a treatment and that drug was covered by their previous insurance plan cannot be switched to a different medication.  

Health care providers want to protect our patients from becoming another sad statistic. And we could use policymakers’ help in curbing insurance practices that make that more difficult. The Safe Step Act is a hopeful start. 

Dharmesh Patel, MD, is a practicing cardiologist in Southaven, Mississippi and a member of the Partnership to Advance Cardiovascular Health and the Alliance for Patient Access.  

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