Maine Delivers Patient Victory on Non-Medical Switching

July 3, 2018

In a week already marked by fireworks and parades, patients in Maine have one more thing to celebrate.  A new state law draws clear lines about non-medical switching, protecting chronic disease patients who want to stick with the doctor-prescribed medicine that keeps them stable.

While non-medical switching takes a variety of forms, insurers often use formulary changes to drive stable patients to drugs that are less expensive for the health plan.  Such changes disrupt care for patients who’ve struggled to get chronic conditions under control.

“Mainers deserve stability and predictability in their health care treatment,” explained Maine Reps. Bob Foley and Heather Sanborn in the Portland Press-Herald.  The pair co-sponsored LD 696, now a Maine law that offers important protections.

First, the law requires clear communication with patients who may be affected by formulary changes.  Insurers must give affected patients 60 days’ notice before the plan makes a change to its formulary of approved drugs that would impact those patients’ medicine regimen.  Second, insurers must now notify patients of their right to request an exemption.  Such an exemption would allow them, despite formulary changes, to continue accessing the medication that keeps them stable. Third, insurers are required to provide affected patients with the form for requesting an exemption.

And the law doesn’t stop there.  Insurers must also provide coverage for the drug while the patient is completing the exemption request process.  And if a patient has worked through the prior authorization process, that patient is assured coverage for his or her medication until the authorization period expires.

Finally, the law demands greater accountability for health plans.  Insurers must report to the state any changes to their formulary – including rationale for the change and an estimate of the number of beneficiaries impacted.  Insurers must also report the number of exemption requests and the outcome of those requests.

As statehouses across the country work to understand what non-medical switching is – and how it hurts stable patients – Maine’s law offers a template for legislators who want to protect patients.

Derek Flowers of the Keep My Rx campaign, which champions patient protections against non-medical switching, said, “With these bipartisan reforms, Maine has distinguished itself as a trailblazer with LD 696.  Lawmakers should be commended for their commitment to patients’ access to the medications that keep their chronic conditions stable.”

While a handful of other states offer limited protections, Maine’s law is the most robust effort yet to hold insurers accountable for the impact of non-medical switching on patients.

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