Switching Arthritis Medication

When chronic illness patients or caregivers in our community select an insurance plan, they often pick one based primarily on whether that plan offers their particular drug at an affordable out-of-pocket cost.

So it’s understandable how horrified and frightened our community members are when they are notified that their treatment is no longer available at the same copay or coinsurance rate just months into their insurance plan’s contract year.

Trapped in the health plan for the remainder of the year, patients are financially incentivized to switch their therapy to the drug that the insurer has newly anointed with more feasible out-of-pocket costs. But this might be not be the ideal treatment for their health condition.

The patient advocacy community recognizes this scenario as non-medical switching, and it’s a health care policy that our parent nonprofit organization, the Global Healthy Living Foundation, has been actively advocating against for years.

We’ve educated thousands of patients about what non-medical switching is and how it may affect them. We’ve helped patients who’ve been affected by non-medical switching speak out in their states and let legislators know the impact that such policies have on their care. We’ve been involved with other patient groups in helping to pass legislation in seven states around the U.S. that prohibits health insurance plans from implementing non-medical switching policies.

That’s why we’re particularly excited that our organization’s home state of New York just passed its own non-medical switching legislation in both the Senate (Senate bill 2849) and Assembly (Assembly bill 2969). The bill will still need to be signed by New York Governor Andrew Cuomo in order to officially become law.

What the Non-Medical Switching Law Does

The law adds common-sense reforms to the rules that insurance companies must abide by when deciding which medications to cover and ensure that health plans don’t change their insurance formulary (their drug list) in the middle of the year.

This means that the health insurance plan that patients sign up for during open enrollment is the plan they get — and keep — for the entire year.

Last year the Global Healthy Living Foundation collaborated with more than 30 patient and clinician advocacy organizations to survey chronic illness patients and caregivers about their experiences with non-medical switching.

How Non-Medical Switching Affects Patients’ Health

Almost two-thirds reported that their insurance company switched their medication to a one that was different from the one their physician prescribed. This, in turn, caused 54 percent of those surveyed to trial multiple medications before finding a replacement that worked for them. Unfortunately, nearly 72 percent of people said they found their new medication to be less effective than the original one they were forced to switch from and more than 90 percent of patients reported that their side effects were worse. About 35 percent of patients who were non-medically switched reported having to see their physician, go to an emergency room, or both due to non-medical switching.

The Global Healthy Living Foundation has been advocating alongside such other patient groups as the AARP, the American Lung Association, and the National Multiple Sclerosis Society to pass this bill over the past four years. It passed the Assembly each year it was introduced but failed in the Senate.

In 2018, we participated an advocacy day and press conference in Albany to share our survey results with legislators. At a press conference, our patient advocate Lisa M. shared her story about dealing with insurance companies who tried time and time again to switch her children’s medications despite the fact that her family had met their deductibles and her children were stable on their medication.

“When you have a child with medical needs there is so much uncertainty and insecurity surrounding their treatment, medicines, dosages, side effects, and cost,” Lisa says. “Once you have all of that figured out, there shouldn’t be any uncertainty and insecurity that the whole thing will change because of a cost-cutting decision by your insurer.”

Victory for Patients Everywhere

We are happy to say that our work and the work of countless advocates alongside nonprofit and professional groups has just made New York a fairer state for people living with chronic disease.

“The passage of this bill ensures that patients in the New York Global Healthy Living Foundation community can select their health plan each year with the knowledge that their coverage will remain consistent and they will not need to alter their treatments unless it is recommended by their doctor for medical purposes,” says Corey Grenblatt, MPH, manager of policy and advocacy at the Global Healthy Living Foundation.

Together we are stronger.