Non-Medical Switching

WHAT TO KNOW

Why do insurance companies use non-medical switching?

In the modern healthcare environment, insurance companies regularly review and change coverage tiers and policies regarding specialty medications, or ‘biologic’ drug coverage.

When prescription drug coverage changes are made, insurance companies notify patients that they may need to switch medications to one less expensive(based on how they’ve evaluated and reorganized their drug coverage policies) to avoid an increase in out-of-pocket costs. This is known as “non-medical switching”.

 

Can non-medical switching harm patients?

Yes, unnecessary medication switches can erode patient health & increase costs.

When dealing with patients who have complex, chronic, or rare conditions, changing a stable patient’s medication put the patient’s health at risk, potentially causing adverse side effects and decreased effectiveness of their medication. One recent study of Crohn’s Disease patients found that switching from one therapy to another was associated with loss of effectiveness within one year.

For a patient on a biologic medication, a switch can result in immunogenicity, which is an immune response that can lead to a severe allergic reaction and potentially cause patients to no longer respond to therapy.

These unintended health consequences translate to increased ER visits, hospitalizations, physician visits and lab tests – which also drive up health care costs.

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