Non-Medical Switching: Insurers Playing Doctor

Updated: Apr 9, 2018


This past year, I've begun dipping my toes into the policy water because as an advocate, fundamental changes are needed across healthcare from the bedside all the way to capitol hill.


With that in mind, I am currently serving on a special commission to study switching medications in Massachusetts where we are tasked with drawing up a report that captures the health and economic burden of non-medical switching. 


Non-medical switching is an increasingly popular practice by insurance agencies whereby patients are switched from their current medication to a less expensive therapy for non-medical reasons not approved by a patient’s doctor.


My role on the commission is to provide the patient perspective. I've seen first hand how devastating non-medical switching can be to patients which is why I am a strong opponent of the practice. 


The Patient Access and Safety Coalition, comprised of patient and provider groups in Massachusetts, has teamed up with the Global Healthy Living Foundation to develop a survey which compiles the stories of patients who have experienced non-medical switching. This data will be used to better inform the Commission and legislators on the impact of non-medical switching.


If you or a loved one have experienced non-medical switching, I encourage you to PLEASE fill out this survey to help facilitate change.


Unsure what non-medical switching is? I developed a guideline originally published in AARDA's InFocus Newsletter to help break it down. 


What is non-medical switching?

Non-medical switching is an increasingly popular practice by insurance agencies whereby patients are switched from their current medication to a less expensive therapy for non-medical reasons not approved by a patient’s doctor.


How do insurance companies practice non-medical switching?


Insurers encourage non-medical switching in the following ways:

  • Limiting or completely restricting access to the medication

  • Increasing out of pocket costs and/or switching the medication’s tier to encourage patients to select a less expensive medication

  • Offering pharmacists and health care providers financial incentives to switch patients to a different drug preferred by the insurance company

How does non-medical switching impact autoimmune disease patients?


Insurers are trying to play doctor and it has the potential to lead to serious medical consequences for autoimmune disease patients.


It’s no secret that AD patients often go through a long and painful struggle in search of an effective treatment. An ongoing survey from AARDA confirms this notion. 95.9% of autoimmune disease patients had to try more than one medication before they found the one that worked. The average time it took to find the right medication was 2.9 years.


Even more concerning, when autoimmune patients were switched off of a medication that was keeping them stable for non-medical reasons, 37.21% said their condition worsened and 35.8% experienced side effects.


Switching a patient’s therapy for non-medical reasons can have a devastating impact, triggering an autoimmune disease to flare and burdening patients with pain, frustration and financial consequences.


How you can help:


Let your representative know that you don’t want your insurance company “playing doctor”. Remember to share these key points when communicating why non-medical switching is a dangerous practice:

  • If you live in MA and are a patient or caregiver who has experienced non-medical switching, take the survey!

  • Share your patient/caregiver story: How long did it take you to find a medication that works? How would your life be impacted if you were suddenly taken off your medication and switched to a different one?

  • Share the statistics: Go to www.aarda.org to leverage the startling statistics from AARDA’s ongoing survey.

  • Share the unintended cost: Non-medical switching is not only a dangerous practice by insurance companies but a costly one. Patients who are switched off of a medication that was keeping their symptoms under control are more likely to end up in the ER and endure countless doctor’s appointments to try and manage a disease flare caused by the switch.

Exciting news! I've officially launched Patient Authentic. To learn more and collaborate head over to www.patientauthentic.com!