In the US, up to 70% of prescription medicines are changed by health insurers in order to save money, a new survey has found.
This is not a simple case of switching a brand-name drug for a generic, which is “a common and generally-accepted practice,” but of switching one brand-name drug for another simply because one drug is cheaper, says the Global Healthy Living Foundation (GHLF), a patient advocacy group which conducted the survey.
“If the drugs are identical, physicians generally have no objection, the survey found, but national medical groups have said most drugs are not identical,” said GHLF executive director Louis Tharp. “Switching can cause adverse reactions and poor recovery rates,” he added.
The survey also found instances of patients with chronic conditions who were responding well to a particular drug but relapsed after being switched to a cheaper drug. “When patients are switched so the health insurance company can save a few pennies and then the patient’s chronic condition worsens, not just the patient, but the entire economy suffers when these people miss work, are admitted to hospitals or can't take care of their families,”
said Mr Tharp.
The GHLF says it is conducting an additional national survey to measure the incidence of so-called “fail-first practices,” in which health insurers require a patient to fail on a cheaper drug before being considered for the original drug their physician has prescribed. Mr Tharp described as “very worrying” the survey’s finding that some insurers require a patient to fail on a drug that is not approved by the Food and Drug Administration (FDA) to treat the diagnosed condition before being allowed to take medication that has been approved by the agency.
The GHLF is working with other advocacy groups, state insurance commissioners, the FDA and state attorneys general “to see what action can be taken to stop this dangerous practice,” said Mr Tharp, and he also advised patients and physicians to go to www.failfirsthurts.org, a website created by the GHLF, for information about how to avoid having prescription drugs switched by health insurance companies, and how to effectively complain when this happens.
A number of US states - New York, California and Missouri - have legislation pending to outlaw switching, while Louisiana has already passed a law prohibiting the practice. Mr Tharp said he expects several more state legislatures to take up the issue in 2011, because “legislators realise that health insurers are practicing medicine without a state-issued medical licence when they come between the physician and patient.”
One example is likely to be South Carolina, whose medical association announced in November that it will be launching a campaign early next year to “more fully educate the public and lawmakers about what can be done to reverse this troubling trend,” after a survey found that 97% of responding physicians said they had had to change a prescription medication due to restrictions imposed by an insurance company.
81% of those responding to the poll agreed with the statement: “I feel that sometimes I am being pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient,” and 91% said there should be enforceable legislation regarding restrictions that insurance companies put on physicians.
Moreover, 90% told the survey that they did not believe communication from insurance companies to patients is accurate, fair and provides an unbiased side risk/benefit profile when they are requesting a change to treatment prescribed by their physician.
“It is imperative that we take a second look at pre-approval requirements, step therapy protocols and therapeutic switching policies in order to ensure that all South Carolinians have the protected relationship with their doctor that they deserve. If not, we are in danger of having medical decisions made by insurance companies rather than physicians,” said Todd Atwater, chief executive of the South Carolina Medical Association (SCMA).