New Insurance Strategy Pits Patients Against Their Pocketbooks

June 30, 2021

Which would you choose – $500 or the medication that effectively manages your condition? It’s a tough choice, but one that patients across the country now face.

Insurance giant Cigna recently began offering psoriasis patients a $500 debit card to switch their prescription to a drug preferred by the company’s pharmacy benefit manager. The preferred drug may be more lucrative for the company but is not necessarily medically appropriate for the patient.

Clinician Outcry

The American College of Rheumatology, citing “serious ethical concerns,” called on the Cigna to end the practice immediately. 

The American Medical Association soon followed suit. The physicians group adopted a formal resolution discouraging the practice for creating “needless risk” for patients who are stable on their current medication. 

The association also encouraged state and federal regulators to prohibit the unethical tactic. 

Business as Usual

To many patients, $500 is too much to walk away from, even if it means making medical decisions based purely on financial factors.

Despite the outcry, however, the debit card offer is only an extension of standard practices. Pharmacy benefit managers’ practices and policies are often at odds with patient-centered care. 

For example, the companies routinely profit off of non-medical switching. The practice entails changing coverage rules to drive patients from their current medication to another drug that is more profitable for the company. But compelling a treatment change mid-course can pose risks to patients’ health and mental wellness.

Prioritizing Patients

In a patient-centered health care system, business incentives should align with patients’ needs, not the other way around.

That will require pharmacy benefits managers to stop undermining clinical decision-making, incentivizing risky decisions and padding their bottom lines at the expense of patients.

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