Nonmedical switching occurs when insurers force stable patients onto medications other than what their clinician recommends.
Patients, especially those with chronic conditions, may go through months or even years of trial-and-error to find the right treatment. For these individuals, stability is hard-won. But many insurers are jeopardizing patient stability by making coverage changes that reduce or eliminate coverage for vital medication. Worse yet, insurers are making coverage reductions in the middle of the contract year, when patients are locked into the plan.
Nonmedical switching can take many forms.
Nonmedical switching can result from various types of reductions in coverage, such as:
- increasing out-of-pocket costs,
- moving medications to more expensive tiers,
- or removing medications from the coverage plan entirely.
Nonmedical switching is unfair and unsafe—and it may actually increase health care costs.
Nonmedical switching is fundamentally unfair to all consumers, but it disproportionately affects patients with chronic conditions, including chronic pain. When patients lose access to the therapy that stabilizes their condition, they may also lose the ability to manage their disease, face re-emerging symptoms and new side effects. As a result, patients may require extra appointments with their physician, lab tests, visits to the emergency room and even hospitalization—making the “less costly” alternative an expensive option for patients and insurers alike. For more detail about the proven negative effects of nonmedical switching, go here.