Non-medical switching occurs when patients have been “switched” to a new medication without their consent or the consent of their doctor.

In general, non-medical switching forces patients to be switched to a generic or brand medication, usually based on cost, and without patient or physician approval. Switching can occur in the middle of an insurance year, even if a patient has picked that insurance because of its prescription coverage.

One of the many problems with non-medical switching is that it interrupts the physician-patient relationship and their history together. Patients with chronic health disease and their health care providers go through a long period of trial and error to find the right prescription medication and dosage that provides the patient with a stable health outcome, a predictable health regimen, and an improved quality of life. But non-medical switching compromises the patient’s health, drives up the patient’s cost, and, increases costs to society.

Non-medical switching occurs for reasons usually unrelated to health. This switch is more often than not driven by health insurance plan design or policies to ensure that the insurance plan saves money.

Examples of non-medical switching include:

• Removing the patient’s drug coverage from their formulary plan
• Increasing the patient’s out-of-pocket costs to stay with the drug that is working
• Moving drug treatments to prohibitively priced tiers
• Creating dosage and refill restrictions that limit the patient’s dosage that have been proven by the patient to work.

First, learn about the process. The State of Michigan’s Department of Insurance and Financial Services (DIFS) has created an informational video, a powerpoint, and a brochure to educate you on how to resolve a grievance with your health plan or insurance company, including grievances related to your prescription medicine coverage––and, if you are still not satisfied, how to file a complaint with DIFS. While there is no guarantee that you will get the result you seek, you will put yourself in a better position if you follow the process.

Read the DIFS Brochure Guide to Resolving Health Insurance Problems (PDF)