Objective: To demonstrate the adverse impact of non-medical switching on patient care.

Background: Non-medical switching (NMS) is a policy under which insurers or their pharmacy benefit managers force stable patients to change medicines to save money. NMS can happen in several ways: Insurers remove a medication from their formulary or place certain medicines on a specialty tier. Specialty tier drugs have higher out-of-pocket costs to patients, which can make them unaffordable. The increased financial burden forces patients to switch to a different medication. For movement disorders patients who must carefully manage complex conditions, NMS poses significant risks. Some patients may even abandon their medicines as a result of being switched. NMS also leads to increased health care costs in the form of more frequent doctor’s visits, preventable hospitalizations, and other downstream system costs.

Method: Between Jan. 8 and Jan. 13, 2019, an online poll of 800 patients (including movement disorders patients) who had experienced NMS was completed.

Results: Nearly 60 percent of respondents indicated they experienced one or more complications due to the switch. These complications included re-emergence of previously controlled symptoms (28%), side effects (35%) or adverse interaction with other medicines (10%).[1] Additionally, 40 percent of patients reported increased frequency of visits to their clinician and nearly one in 10 required hospitalization after being non-medically switched.[1]

Conclusion: NMS has a severe impact on patients’ health. Losing access to clinician-prescribed medication can lead to re-emerging symptoms, new side effects, or adverse drug interactions. NMS also unnecessarily increases health care system costs through increased visits and preventable hospitalizations. For movement disorders patients managing complex, progressive conditions, treatment stability is critical. NMS unnecessarily compromises these patients’ health by allowing a cost-saving health plan policy to usurp the clinical judgement and individualized care plan determined by each patient’s physician. Policymakers and health system leadership should take into account the negative effects of NMS and take steps to limit it. Policymakers and health plan leadership should consider the following to protect patients from NMS: 1. gain patient consent before changing patient medication and 2. maintain coverage for a patient’s already established medication.

References: 1. Alliance for Patient Access. A study of the qualitative impact of non-medical switching. February 2019. Retrieved from: http://allianceforpatientaccess.org/wp-content/uploads/2019/02/AfPA_Qualitative-Impact-of-Non-Medical-Switching_Report_Feb-2019.pdf

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/non-medical-switching-impact-on-movement-disorders-patients-access-and-care/