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Organization Discusses Impact of Nonmedical Switching on Patients


Two leaders of the Alliance for Patient Access discussed results of a survey and focus group about nonmedical switching of patients from one drug to another by payers and pharmacy benefit managers for reasons of cost.

During a session at the Alliance for Patient Access 4th Annual National Policy and Advocacy Summit on Biologics and Biosimilars, a conversation addressed the topic of nonmedical switching and the impact on patients.

Brian Kennedy, the executive director of the Alliance for Patient Access (AfPA), and David Charles, MD, the chairman of AfPA, discussed results of a survey and focus group that the organization released in February 2019. AfPA opposes switching patients from one drug to another by payers and pharmacy benefit managers for reasons of cost. The survey asked questions about the impact of nonmedical switching on work and home activities, and symptoms such as anxiety.

Nonmedical switching can be “disrupting and damaging,” the survey concludes.

“Do your patients perceive this?” Kennedy asked Charles, a neurologist and chief medical officer at the Vanderbilt Neuroscience Institute.

Charles described caring for patients who are stable, and then switched. “You can imagine how that patient feels,” he said. “Someone wants to come in the room and turn everything upside down.”

What concerns him as a physician, he said, is that according to the study, after being switched, 40% of the patients stopped taking the medicine altogether.

“The patient keeps paying deductibles and they get nothing,” he said.

The organization also feels that nonmedical switching interferes in the doctor-patient relationship, and also drives up other costs elsewhere as a result of the patient stopping their treatment.

Kenny called it being “penny wise and pound foolish.”

“That chronic disease is not going away just because it’s January 1,” he said, referring to the start of another plan year.

Other results of the study found:

  • 66% said switching impacted their performance at work
  • 43% said it impacted family life
  • 83% said it left them frustrated
  • 75% said it left them with anxiety

In addition, 40% said the new medicine was not as effective as the original, and almost 60% experienced a complication from the new medication.

The results came from in-person focus groups of patients who had experienced non-medical switching as well as an online survey with 800 patients.

Those in attendance were cheered by a state law in Maine that requires 60 days’ notice of a change in the formulary; a notification requirement and a method to request an exemption for a patient; continued coverage during the exemption process, and an explanation for the change and the impact of any formulary changes.

Even though the law only applies to state employees or those on an exchange plan, it “puts the physician and patient in a stronger position,” said Kenny.

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