What Is Non-Medical Switching?

Switching Medication Without Consent

What is Non-medical switching? 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 into generic or brand medication , usually based on cost, and without patient or physical approval. Switching can occur in the middle of an insurance year, even if a patient has picked that insurance because of its prescription coverage.

Learn More About Non-Medical Switching

What happens when a drug is removed from pharmacy benefit coverage? What happens when an insurance company switches a patient to a new medication? Learn how Non-medical switching has affected the health of people with chronic conditions in Michigan.

The Physician-Patient Relationship is Interrupted

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.

Understanding Non-Medical Switching

Patients with chronic or serious medical conditions must sometimes work with physicians for months or even years to identify a medication that's effective for them. But as this video explains, patients may discover that this trial-and-error process was in vain. Through non-medical switching, insurers can compel patients to set aside their effective therapy for a less costly alternative-for reasons unrelated to patient health.

Understanding Non-Medical Switching

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.

Why Does Non-Medical Switching Occur?

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.

 

What happens patients are stable on a therapy and their insurer decides to make a change? Learn about Common Barriers to Treatment.

Common Barriers to Treatment