Insurance companies are recognizing the fact that cost-cutting measures like nonmedical switching can be harmful for COVID patients and are suspending these practices during the pandemic. Their decision compels us to ask – shouldn’t such policies be suspended permanently, for all patients?
In Florida, there are no laws regulating nonmedical switching, where insurers try to boost profits by switching stable patients to a less expensive medication. In more than 20 years of practicing medicine, I have seen nonmedical switching, like step therapy or “fail first” requirements, give insurance company bureaucrats, not trained medical professionals, control over which medications patients receive.
There are various ways insurers can switch patients. They can place the higher-priced drug in a health plan’s specialty tier or make other changes that increase the co-pay to an unaffordable level. Insurance companies can even drop a patient’s medication completely from the formulary, the list of drugs the plan covers.
However it is accomplished, switching patients from the drug their doctors want them to have just because another medication costs less is a dangerous practice. It’s especially bad when it moves patients with chronic conditions off a medication they’ve been taking, one that has proven effective in controlling their symptoms.
I have seen patients’ symptoms return or worsen, or they can develop new side effects. That can result in more doctor visits, trips to the ER and even hospitalization. Not only are those outcomes hard on the patient, they are expensive. Nonmedical switching might give insurers a short-term monetary gain, but too often those savings are eclipsed by the greater long-term costs the switch creates.
And it’s a real problem in Florida. Many of our patients in Florida living with a rare or chronic disease revealed that more than two-thirds had an insurer who had changed their formulary to reduce coverage for these patients’ prescribed medications. Three-quarters of them had to change medications because of the cost increases; 58% said the new drug was less effective. Sadly, 88% found the control they had once had over their symptoms was diminished when they could no longer afford their original prescription.
This is a fixable problem. A number of states have instituted controls on nonmedical switching, passing laws that set rules for insurers and give patients and health care providers a workable method for appealing an insurer’s decision. Unsurprisingly, the same survey that found nonmedical switching was an issue for many Florida patients also revealed that 94% of affected patients would support such legislation.
The Florida Legislature has yet to act on nonmedical switching. Legislation was introduced this year in both the state House and Senate that would have put some restrictions on formulary changes, but the bills died in committee.
When it comes to nonmedical switching, Floridians want more from their lawmakers. All Florida voters should let their elected officials know that it is time to follow the lead of other states. It’s time to pass effective controls on nonmedical switching and other insurance practices that stand between patients and the medications their doctors have prescribed.
Dr. Teshamae Monteith is an assistant professor of clinical neurology at the University of Miami, and chief of the Division of Headache in the Department of Neurology.