by Amanda Conschafter, blog editor
Patients with chronic or serious medical conditions must sometimes work with physicians for months to identify a medication that’s effective for them. But as a new video from the Alliance for Patient Access explains, patients may discover that this trial-and-error process was in vain. Through non-medical switching, insurers can compel patients to set aside their effective therapy for a less costly alternative—for reasons unrelated to patient health.
As “Understanding Non-Medical Switching” explains, this medication swap can take different forms:
- Insurers may reduce or eliminate coverage for the originally prescribed medication
- Health plans can block the use of co-pay coupons that help make drugs affordable for patients
- In some instances, insurers have offered financial incentives for pharmacists or health care providers to swap a patient’s medication for a less expensive drug.
Patients who lose access to their physician-prescribed medication can face re-emerging symptoms or side effects – hurting patients and introducing new expenses for insurers through doctor or emergency room visits, lab tests or hospitalizations.
In response, several states have introduced legislation to restrict non-medical switching. These bills may:
- Require pharmacists to communicate switches to prescribers
- Require the doctor’s approval before dispensing a different drug
- Prevent health plans from making formulary changes that restrict access for specific patient groups.
To learn more, watch “Understanding Non-Medical Switching.”