New IfPA Data Support Non-Medical Switching Concerns

Preliminary data from the Institute for Patient Access suggest what opponents of non-medical switching have long suspected: having medications switched for financial reasons could be bad news for patients with chronic diseases.ifpa thmbnail

Entitled “Cost-Motivated Treatment Changes: Implications for Non-Medical Switching,” IfPA’s health analytics brief outlines a recent analysis of Medicare Part B data for patients with rheumatoid arthritis, Crohn’s disease or immunodeficiency. IfPA used the 2011-2014 Medicare 5% Standard Analytical Files to assess patient use of medications and biologics covered by Medicare Part B, as well as Medicare spending before and after switches occurred.

Medicare data do not explain why a change in treatment occurs. To analyze cost-motivated treatment changes, therefore, researchers looked at switches to a materially lower-cost drug. (Researchers assumed that switching to a higher cost drug was most likely not cost motivated.)

Research Findings

Future data on private health plans will shed more light on the impact of non-medical switching. But, for now, IfPA’s data suggest that cost-motivated switching can affect:

1) Overall costs.

Patients with rheumatoid arthritis who switched to a less expensive treatment had Medicare payments that increased from the previous year.

  • Payments for patients with no gap in therapy and one medication switch increased by $8,711.52.
  • Payments for patients with no gaps in therapy and two medication switches increased by $8,827.32.

Meanwhile, stable rheumatoid arthritis patients experienced substantially lower annual cost increases than their peers did.

  • Patients on the same treatment for 91-180 days had a $9,390.60 yearly increase in Medicare payments.
  • Patients who were stable on the same treatment for 271 days or more, however, had a yearly increase in payments of just $201.24.

2) Course of care.

After a patient switched medications once, his or her course of treatment was more likely to be interrupted by a second switch during the two-year data period.

  • Of the 8.1% of patients with Crohn’s disease who switched Part B therapies during the study period, 44.6% switched a second time.
  • Of the 9.9% of patients with rheumatoid arthritis who switched Part B drugs once, 32.6% switched a second time.
  • Of the 29.4% of patients with immunodeficiency who switched Part B drugs once; 46% switched a second time. 

Moreover, cost-motivated switches led to a higher rate of second switches for rheumatoid arthritis patients. Of the patients with rheumatoid arthritis whose first switch was to a more expensive Part B drug, 25.9% switched a second time. Substantially more patients, 37.1%, switched a second time if their first switch was to a less expensive Part B drug.

Policy Implications

Further research is needed to more fully understand cost-motivated switches and their consequences. Given the data in this report, however, IfPA argues that “health plans should approach issues of non-medical switching with caution, recognizing that switching the medicines of stable patients may disrupt patients’ course of care and result in higher costs.”

Read IfPA’s policy brief or see the full report, courtesy of The Moran Company, for more information.

Tags: ,

Categorized in: