Illinois Joins Maine in Limiting Non-Medical Switching

September 4, 2018

What do Maine and Illinois have in common?  Legislators in both states are heeding patients’ concerns about non-medical switching this year.  Following Maine’s success this summer, Illinois signed new protections into law last week that ensure continuity of prescription drug coverage for the state’s residents. 

With Governor Bruce Rauner’s signature of House Bill 4146, Illinois took a stand against insurers’ practice of forcing patients off their physician-prescribed medication in favor of a cheaper, plan-preferred alternative.  The Illinois Fair Care Coalition, an organization of state-based and national patient and health care provider groups, applauded the governor’s action, calling the law a “victory for children and adults living with chronic illness.”

Public Act 100-1052 affords patients two primary protections:

  1. It restricts health plans from removing a drug from formulary or changing the drug’s preferred or cost-sharing status without at least 60 days’ notices to enrollees.  Insurers are required to tell patients about the exception process.
  2. It allows health care providers to certify when a prescription is medically necessary for their patient.  Once a provider makes that attestation, a health plan must cover the medication as they had previously — without any change in cost to the patient for the remainder of the plan year.

These provisions protect the patient-physician relationship and respect the treatment plan the pair have jointly agreed upon.  Abrupt medication changes can destabilize well-managed conditions, causing symptoms to re-emerge. And it doesn’t generate cost savings for insurers.

A 2017 analysis from the Institute for Patient Access found that cost-motivated medication changes can result in higher average non-drug expenses later on.  The paper explains that, “patients who underwent multiple switches also saw higher average non-drug costs downstream.”

Public Act 100-1052 will take effect January 1, 2019.  Representative Laura Fine and Senator Heather Steans sponsored the legislation.

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