Cost-Motivated Treatment Changes & Non-Medical Switching: Commercial Health Plans Analysis

Non-medical switching occurs when health plans drive stable patients to switch from their current medication to a less expensive alternative. It can occur several different ways: by changing the list of approved drugs, by incentivizing pharmacists or physicians to switch a patient’s medication, or by limiting or eliminating the use of co-pay coupons that patients need to afford their medication.

Non-medical switching can hurt patients, who may see symptoms re-emerge or lose ground on stabilizing chronic conditions. Given non-medical switching’s detrimental impact on patients, the Institute for Patient Access was compelled to ask: Does non-medical switching actually generate the cost savings that health plans envision?

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