The Global Healthy Living Foundation (GHLF), released the findings of a national survey of stabilized autoimmune patients that explored their perspectives on switching prescribed biological medicines. The survey, “Patient Perspectives on Medication Switching for Non-Medical Reasons,” found 98 percent of the 177 eligible respondents said insurance companies and pharmacists should not switch effective therapies without patient and physician notification.
Patients with autoimmune diseases such as rheumatoid arthritis rely on expensive complex drugs called biologics to be productive members of society. A strong patient-physician relationship is key to finding the most effective biologic drug for a patient. It can take several years of trying different options before finding the most appropriate for a particular patient.
“Patients often spend years working with their healthcare providers to find the right medication for their condition” said GHLF Executive Director, Louis Tharp. “This is compromised when insurers decide to stop covering a drug that has been working for a patient. Now a patient is forced to pay out of pocket or switch,” he said.
Insurance companies use a tier system to determine reimbursement and out-of-pocket costs for beneficiaries. When establishing their formulary tiers for a drug class, insurers compare drugs based on clinical value and price. The lowest priced drugs with comparable clinical effectiveness are regularly selected as an insurer’s “preferred drug”. This evaluation process as well as changes to covered drugs can play out once, or multiple times, a year depending on the insurance company and plan. Often times when a drug or series of drugs are dropped from a plan the patient and physician are not notified of the change. Patients are then required to switch to whichever drug(s) the insurer has newly selected as its preferred (cheaper) option. Whether or not a patient and physician have tried those therapies and failed in the past is not considered.
The survey revealed stabilized patients have widespread health and financial concerns about switching biologics without patient and physician notification.
Please follow the links below to the press release, executive summary, and info graphic of survey results provided below for more information on the perspectives shared by surveyed patients.