Cardiovascular disease remains a leading cause of death in the United States. But patients who rely on specialty medications to keep their heart conditions under control now routinely see their care interrupted by insurance requirements. One common practice is known as non-medical switching.
Non-medical switching occurs when an insurer changes the formulary of drugs that they previously covered, prompting patients to abandon effective medications. It’s an external, extraneous process that poses dangerous complications for heart patients.
Treatment plans for heart patients are carefully tailored to one’s medical history and risk factors, and switching medications in search of cost savings risks destabilizing that care. While contracting and rebate arrangements that trigger formulary changes may help reduce costs for those health plans, a real price is paid by patients who are already stable, but suddenly can’t access a trusted medication.
Disruptions Has Consequences
A medication change, even between closely related drugs, often requires additional office visits and laboratory tests. Patients who were responsive to one drug may find the new form less effective, or experience new side effects.
In surveys, patients who had tried several different blood thinners before finding one that worked experienced new health concerns when compelled to switch medications. Of those who were required to make the change:
- 28% reported new side effects.
- 22% had treated symptoms resurface.
- 43% needed additional office visits.
Non-medical switching can also take a toll on patients’ mental health. Measurable increases in anxiety and reductions in treatment adherence accompany these cases of non-medical switching. Adherence dips as well under non-medical switching; If a prescription takes several extra days or office visits to refill, some patients will forgo treatments altogether.
Putting Patients Over Prices
Non-medical switching is not designed to improve a patient’s condition, and it may introduce new risks by disrupting established care. Treatment decisions are best made by clinicians in close consultation with their patients, based on clinical histories, individual health needs and medical evidence. Avoidable cardiac events, complications and hospitalizations are likely to result from insurers switching medications over the trusted advice of clinicians and patient experiences.
Health plans play an important role in managing costs, but practices that push patients off stable treatments are likely to cost as much as they save. Coverage policies that preserve effective care and minimize unnecessary medication changes help protect patient safety.
Patients should have access to the medications their clinicians prescribe, not just what their plan chooses to cover. Policymakers must end the practice of non-medical switching.
