Diabetes Patients’ New Challenge: Non-Medical Switching

October 3, 2017

“Managing diabetes is an all-day, every-day task for millions of Americans,” explains a new video from the Diabetes Policy Collaborative.  But just when patients have an established regimen – regularly checking blood sugar, injecting insulin, exercising and eating right – their health plan can introduce new complications through non-medical switching.



The Diabetes Policy Collaborative, an advocacy group that focuses on access to medical care and treatment, sees this as a real problem for patients.

“Non-medical switching” is an umbrella term for techniques that push stable patients to medications that are less costly for the health plan.  The health insurer may exclude a specific insulin or medication from its formulary of approved drugs, or switch the drug to a coverage tier that requires higher out-of-pocket costs, pricing patients out of access.

For some patients, the switch has no meaningful effect.  But others are not so lucky.

“I personally know patients who’ve had boils appear at the site of insulin injection,” explained Stewart Perry of the National Diabetes Volunteer Leadership Council, referring to an incident depicted in the video, “or really struggled to get their blood sugar back in range.”  Perry is also former chairman of the American Diabetes Association’s national board of directors.

The video argues that non-medical switching disrupts the delicate balance of therapies and lifestyle choices that allows each patient to manage diabetes.

Now, as the video notes, some state policymakers are stepping in.  Several states have considered legislation that would provide stable patients continued coverage for drugs that treat chronic conditions.  This legislation could help people with diabetes maintain their regular treatment, the video explains, and continue managing the ongoing challenges of life with the disease.

To learn more, watch “Diabetes and Non-Medical Switching.”

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