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Survey Finds Insurance Companies are Forcing Floridians Off Prescribed Medications During the Plan Year, Providing A Need for New Legislation to Fix the Problem
Nearly all respondents (94%) support legislation prohibiting insurance companies from financially pressuring them to switch from their prescribed medication
UPPER NYACK, NY (January 17, 2017) – A coalition of 36 patient and provider organizations known as the Floridians for Reliable Health Coverage today released results of a survey showing that a majority of Floridians living with chronic health conditions have experienced “non-medical switching”—insurance coverage reductions which pressure patients to switch their prescription medications. Reductions in coverage include increased out-of-pocket costs, eliminating a drug from the formulary entirely or other restrictions around access. The results of the survey, which was conducted by the Global Healthy Living Foundation (GHLF), support state-level action on the issue. Non-medical switching is quickly becoming a critical issue for patient and provider groups across the country, including Florida where HB 95/SB 182 have been filed to restrict the activity by commercial health insurers. Related legislation was proposed in eight states in 2016.
“Annually, when a Florida resident signs up for insurance their contract is very specific. But what may not be apparent is that their insurer is allowed to alter the contract by reducing their drug coverage at any time during the plan year,” stated Seth Ginsberg, president and co-founder of GHLF, whose mission is to improve the quality of life for people with chronic illness and is a member of the Floridians for Reliable Health Coverage. “Not only is the contract unfair to consumers, but it puts patients’ health at risk when access to their medication becomes uncertain. We are pleased to hear that legislation is being introduced in Florida–it’s time for legislators to protect patients from non-medical switching.”
While consumer fairness is a main concern, patients and providers argue non-medical switching is harmful to patient health and undermines providers’ efforts to do what’s best for their patients. The survey found that over two-thirds (68%) of Floridians with chronic illness have had their insurer make changes to their health plan’s formulary that reduced coverage of their prescribed medication. The reduction in coverage was so dramatic that the primary medication they were using to control the symptoms and progression of their disease became suddenly and significantly more expensive. Nearly three-fourths of the respondents (74%) were unable to afford the increase in out-of-pocket prices and were forced to switch to an entirely different medication.
“People with HIV, epilepsy and other chronic disease will spend weeks, months or even years seeking an effective treatment regimen,” stated Jason Goldman, MD, FACP, the Governor of the Florida Chapter of the American College of Physicians, another member of the Floridians for Reliable Health Coverage. “An insurance company completely disregards the severity of destabilizing a patient with a chronic disease when they make it more difficult or impossible for that patient to access or afford the medications they prefer and that are recommended by their health care provider. These insurers may lower their drug costs, but will not reduce their overall healthcare costs – data shows that switching medications often increases provider visits, emergency room trips and even hospitalization.”
Beyond the health and cost implications, the survey found almost half (48%) of all respondents never received notifications from their insurer (letters, emails or phone calls) detailing their plan’s midyear formulary changes or modifications being made to their health plan coverage.
The coalition is advocating to reduce non-medical switching by commercial health plans in Florida. It includes GHLF, U.S. Pain Foundation, Epilepsy Foundation Florida, American College of Cardiology (Florida Chapter), The AIDS Institute, Epilepsy Association of Central Florida, International Foundation for Autoimmune Arthritis, National Patient Advocate Foundation, Florida Gastroenterology Society, American Academy of Pediatrics Florida Chapter, Florida Academy of Family Physicians, Lupus and Allied Diseases Association, Inc., Suncoast Epilepsy Association, The Florida Society of Dermatology & Dermatologic Surgery, NAMI Florida, Florida Legal Services, Inc., Florida Osteopathic Medical Association, Florida Society for Respiratory Care, Inc., H.E.A.L.S. of the South, Epilepsy Association of the Big Bend, Force Empowered, Florida Developmental Disabilities Council, Inc., Lupus Foundation of Florida, Florida Medical Association, Budd Bell’s Clearinghouse on Human Services, The Arc. of Florida, American College of Physicians Florida Chapter, Florida Society of Rheumatology, AIDS Alliance for Children, Mended Hearts, Youth & Families, Florida Society of Physical Medicine and Rehabilitation, Florida State Hispanic Chamber of Commerce, the Florida Psychiatric Society, Arthritis Foundation, Family Café, and FL Pharmacy Association.
“We were not surprised that a huge number of professional and patient societies elected to join our coalition in Florida because we all have urgent concerns about how easily insurance companies disrupt the treatment of patients,” stated Michael Ruppal, Executive Director, The AIDS Institute, which is leading the coalition. “We hope these survey results start a much-needed conversation about how we can protect the provider-patient relationship.”
An executive summary and infographic detailing additional survey results is available on the GHLF website at www.ghlf.org. The Floridians for Reliable Health Coverage plans to continue its outreach efforts to educate patients, providers and lawmakers on the harmful impact of non-medical switching. More information is available at https://www.facebook.com/FlaReliableHealth/
In August 2016, GHLF partnered with the Floridians for Reliable Health Coverage, which represents hundreds of thousands of Floridians living with chronic illness and their care providers. GHLF and the Coalition invited Florida residents living with a chronic or rare illness to complete an online, 57-item survey that investigated patient experiences with the manipulation of their respective health plans’ formularies. In order to complete the survey, eligible respondents had to be residing in Florida and diagnosed by a provider with a chronic or rare disease.
A diverse sample of 62 Florida residents diagnosed with chronic or rare diseases completed the survey. Although respondents’ individual diseases varied widely, five separate classes were represented: autoimmune (35.5%), neurological (30.6%), mental health (14.5%), oncological (4.8%), and other (14.5%). Private insurance was held by the most number of respondents (53%), followed by public insurance (29%), followed by a combination of private and public insurance (6%). Eleven percent of respondents did not provide their insurance type.
Non-medical switching occurs when changes are made to a health plan’s formulary (the official list of available and approved medications) in a way that monetarily pressures patients to cease filling their prescribed medication in lieu of a “preferred” or cheaper drug. Insurers are free to change their formulary at will and often do so mid-plan year. Patients, however, cannot renegotiate their contracts until the end of their plan year. Essentially, patients are not being provided with the benefits that were marketed to them during the open enrollment period.
Non-medical switching can be very harmful to patients. As a result of being switched from their original, provider-prescribed medication, patients may experience additional side effects, symptoms, disease progression, and even relapse. Beyond the immeasurable impact of this unnecessary suffering, the negative effects of non-medical switching can result in additional medical appointments, emergency room visits and even hospitalization, thereby actually increasing overall healthcare utilization costs.
The Global Healthy Living Foundation is a 501(c)(3) non-profit organization whose mission is to improve the quality of life for people living with chronic illnesses by advocating for improved access to care at the community, state, and federal levels, and amplifying education and awareness efforts within its social media framework. The Global Healthy Living Foundation is the parent organization of CreakyJoints, the go-to source for more than 100,000 arthritis patients and their families world-wide who are seeking education, support, advocacy and patient-centered research and the recently launched ArthritisPower, the first ever patient-led, patient-centered research registry for arthritis, bone, and inflammatory skin conditions.