Sometimes patients with skin conditions finally find a medication that works for them – only to be pushed off of it by their health plan. It’s a practice known as “non-medical switching.”
Health plans use non-medical switching as a utilization management tactic to boost their profits. But pushing a stable patient onto a different medication – even one that’s less expensive for the health plan – often introduces new, and potentially expensive complications. It also overrides the decisions that individual patients and their health care providers have made about the best course of treatment.
Arbitrary Medication Switching Hurt Skin Patients
For patients with skin conditions, finding a medication that works may take months, even years. Once patients are stable and benefitting from a medication, pushing them off can create new problems. In a national study of patients who had experienced non-medical switching:
- 40% of respondents said the new medication was less effective than their previous one
- 60% reported experiencing a complication as a result of the new drug
- One in 10 respondents landed in the hospital because of complications related to the switch
Consequences like these put patients’ health at risk and may actually increase health care costs. Meanwhile, non-medical switching can also undermine patients’ trust in their health care provider.
Annual changes in what an insurance company will cover may result in these “switches” happening arbitrarily and often. When a patient with a complex disease is taken off an effective medication, even if he or she is put back on it later, that medication may not have the same effect. The patient may then have no viable treatment options left.
Non-medical Switching is Only One of Skin Patients’ Challenges
Patients who experience non-medical switching have likely faced other access barriers too. Step therapy is a prime example.
With step therapy, a patient starts with an older, lower-cost medication to see if it works, and then “steps up” to the next. In some cases, a patient’s physician advises this approach based upon medical guidelines and best practices. It might make sense to try older and better-understood medications first.
But in other cases, the sequence is required by the patient’s health plan. That can trigger months of failing treatments before a patient can access what their doctor actually prescribed.
Delays can prolong patient suffering while skin conditions worsen. Some patients may, out of frustration, abandon treatment altogether.
Policymakers Are Pursuing Solutions for Skin Patients
Access barriers are common, but skin patients aren’t without options.
Coverage denials can usually be appealed, or patients may be eligible to change to a plan that meets their needs better. In many states, progress is being made to limit non-medical switching that pads insurers’ pockets at the expense of patients. And both state and federal legislators are working to reform step therapy.
The voices of patient advocates continue to drive meaningful changes to improve access to personalized treatment.