4/4/2017 by Share Your Story

Non-Medical Switching: Can insurers change a patient’s medication anytime they want?

Advocates say that under non-medical switching, insurance companies can sell you one health insurance plan, then - after you're locked into a contract -- stop covering the medications they advertised.


Non-Medical Switching: Can insurance companies change a patient’s medication anytime they want?

Patients in Connecticut have good reasons to feel that health insurance is rigged against them. Case in point: non-medical switching. This may be the most scandalous thing patients have never heard of – yet.

Advocates are saying that under non-medical switching, insurance companies can sell you one health insurance plan, then – after you’re locked into a contract — stop covering the medications they advertised.

“It’s bad enough for patients when plans change formularies at the beginning of a contract year, but when it happens midyear, we think that crosses the line over into unethical behavior,” Steve Marmaras, director of advocacy for Global Healthy Living Foundation, told the Pew Charitable Trust. “It’s bait and switch.”

This depressingly obvious “bait and switch” tactic can take many different forms, and all are harmful to patients. For example, an insurance company might remove a life-saving medication from a formulary list in the middle of the year, or it could move an effective treatment to a higher “specialty tier.” Either way, insurance companies pocket bigger profits as patients pay more money out-of-pocket to access the treatment prescribed by their doctor.

Non-Medical Switching can cause serious health complications, side effects

Medications are rarely, if ever, equivalent. So that’s why non-medical switching can have devastating effects on patients. Substituting one medication for another is not the same as swapping out one cola for another. Even the difference of a few nanoparticles can have profound consequences for a patient.

Patients living with mental health challenges may spend months or years finding the right treatment and the right dosage that allows them to work or go to school. Even a few days spent adjusting to a new medication can cause patients to suffer, exacerbating underlying health issues and initiating a downward health spiral.

“There is an inherent absurdity that someone who never examined you would have the authority to override the decision of a trained medical professional with an intimate knowledge of your condition,” says Stacey L. Worthy, executive director of Aimed Alliance.

A switch can also mean lasting damage to a patient’s recovery. In some cases, stopping and then restarting a medication can undermine a treatment’s effectiveness. When this occurs, patients are not only directly harmed, but are likely to require additional, more costly health care. Ultimately, non-medical switching drives up the cost of health care with increased hospitalizations, additional emergency room visits, and more expensive treatments.

“When patients lose access to the therapy that stabilizes their condition, they may also lose the ability to manage their disease, facing re-emerging symptoms and new side effects,” explains U.S. Pain Foundation, a non-profit organization dedicated to serving those who live with pain conditions. “Patients may require visits to the emergency room, additional appointments with their physician, lab tests and hospitalizations as a result— making the ‘less costly’ alternative an expensive option for patients and insurers alike.”

HB 7123: Connecticut bill aims to protect patients from non-medical switching

Earlier this month, Connecticut lawmakers took a first step towards fixing this unfair law when the joint health insurance committee overwhelmingly approved House Bill 7123. The bill, which has garnered bipartisan support, brings fairness and equity to Connecticut’s health care laws and stops insurance companies from engaging in non-medical switching.

“Changing a patient’s prescription without prior warning and while they are still locked into their health plan is a dangerous practice,” said Rep. Michelle Cook, D-Torrington. “It not only interrupts the treatment recommended by a patient’s physician, but can also lead to higher medical costs in the long run.”

Patients, especially those living with chronic illnesses, can spend years working with their doctor to find the best treatment options. They say House Bill 7123 is a matter of fairness and patient safety. Insurers shouldn’t be able to interfere with the treatment prescribed by their doctor.

“As a resident of Connecticut and person living with an incurable connective tissue disorder, this legislation just makes sense,” Shaina Smith of the National Pain Report writes of efforts to fix Connecticut’s law. “If consumers, which includes chronic pain patients, cannot change their health plans in the middle of a plan year, insurers should not be able to alter their prescription drug benefits either.”

To show your support for HB 7123, post on social media with the hashtag: #dontswitchme.

Watch: What is Non-Medical Switching?


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