Non-Medical Switching: A Threat to Patient Health and Wellness

By Lilly Stairs, Founder of Patient Authentic and Interim CEO, AARDA

Non-medical switching is a dangerous practice that affects too many patients each year. It occurs when an insurance company changes its terms or coverage of a medication for reasons that are not clinically based or medically recommended. This requires the patient to stop taking a medicine and switch to a different treatment that has not been recommended by a medical doctor or other qualified provider, but is preferred by the insurance company for financial reasons.

I speak from all too familiar circumstances, having experienced a variety of access restrictions in my battle with three autoimmune diseases. Ultimately, these irresponsible practices are designed to save money, but instead result in a higher costs overtime and threatens patients’ health and wellness.

Recently, Cigna sent a letter encouraging patients to switch from Cosentyx to another drug and incentivized the change by offering individuals a $500 debit card. The letter suggests a number of Cigna-preferred medications instead, many of which do not use the same mechanism of action. In a recent article (subscriber wall), Cigna stated that the financial incentives “are funded solely by Cigna, and the program was designed with consideration for the high cost of inflammatory condition medications and treatments…”

This risky patient “incentive” is unthinkable, unethical, and undermines the vital patient/doctor relationship in determining what medicines and treatments are best for individual patients. In my opinion, preying on individuals who are already carrying the financial burden of living with a chronic autoimmune condition compounded by the economic ramifications of the COVID-19 pandemic is nothing short of cruel bribery.

Let My Doctors Decide, AARDA, and other patient groups, advocates, and providers sent a letter to Cigna about the potential harm this policy will pose to those living with autoimmune diseases and other chronic conditions – independent of the medication cited in the revised policy or its therapeutic alternatives. The joint letter (subscriber wall) strongly encourages Cigna to reverse the policy change, allow patients to stay on the drug that their provider prescribed, and create a seamless pathway for stable patients to remain on this medicine unless and until an alternative treatment is prescribed by their doctor.

Non-medical switching policies pose undue stress, possible interruption of care, and potentially diminished health – especially as we address the fallout from COVID-19.  Last year, Let My Doctors Decide released a set of principles that put patients first and preserve the doctor/patient relationship. These principles:

• Prohibit switching of medication for non-medical reasons without the prescribers’ consent.
• Require that step therapy policies are clinically based on current evidence and used for medical reasons only.
• Leave the final decisions to whether a patient has failed on a therapy with the treating physician, not the insurer.
• Pass rebates, discounts, copay assistance, and other insurer and non-insurer savings directly to the patient at the pharmacy counter.
• Assure what is best for the patients’ health is the top priority and is made transparent in health care contracting, including benefit design and coverage policies.

Non-medical switching is bad business. It’s bad medicine. It’s putting the patient’s health in jeopardy, and it must be stopped.