Non-Medical Switching

Non-medical switching occurs when patients on stable therapies are switched off their medication by their health insurers. This is done by:

  • Assigning a higher co-pay to the medication;
  • Increasing patients’ out-of-pocket requirements;
  • Reducing the maximum plan coverage amount for prescription medications;
  • Eliminating coverage for certain medications; and
  • Formulary changes for non-medical reasons.

Every patient is unique, and it can take years for patients and their doctors to find the right treatment, particularly patients with chronic conditions like asthma or severe allergies. These patients rely on a stable medication regimen to live healthy and experience no or minimal impact to their quality of life.

Unexpected changes in medications can lead to a return of symptoms, increased healthcare costs, and even death. In the cases of asthma and allergies, important considerations about appropriate therapy not only related to the medication selected, but also the delivery device that is used.

It is important for patients and their physicians to remain in control of treatment decisions, rather than an insurer, government, pharmacy or other third parties.

Read more:

https://policylab.chop.edu/sites/default/files/pdf/publications/When_Medication_Switching_Threatens_Care_Of_Children_With_Asthma.pdf