Non-Medical Switching May Increase Health Care Costs, New Study Finds

Opting for cheaper prescription drugs seems like an obvious way to cut health care costs.  The assumption has led health plans to employ utilization management techniques with increasing frequency in recent years.  And it’s given rise to a newer phenomenon known as “non-medical switching,” where health plans exclude a drug from coverage or increase patients’ out-of-pocket burden in hopes of persuading patients to take a less expensive drug.

But new research casts doubt on whether this long-held assumption plays out as health plans would hope.

[READ: Cost-Motivated Treatment Changes & Non-Medical Switching]

Research Summary

In an analysis of commercial health plan claims, the Institute for Patient Access discovered that patients who switch to a less expensive prescription drug actually experience higher non-drug health care costs later on.

Continuity of care, however, keeps costs lower.  Patients who did not switch medications experienced the lowest increase in non-drug health care spending.

These trends held true for a number of chronic diseases, including:

  • Asthma
  • Chronic pain
  • Chronic obstructive pulmonary disorder
  • Crohn’s disease
  • Hypercholesterolemia
  • Multiple sclerosis
  • Osteoporosis
  • Psoriasis
  • Rheumatoid arthritis.


Switching also seems to upset patients’ course of treatment; patients in eight disease states who switched prescription drugs once were more likely to switch again.  Multiple switches also led to higher non-drug health care costs.

“When you take away a stable patient’s access to medication for a chronic condition, you leave that patient struggling to regain control,” explained Derek Flowers, director of the advocacy campaign Keep My Rx. “That means more appointments with their doctors, lab tests, and even hospital stays.  That’s bad news for patients and, as the Institute for Patient Access now shows us, it’s not really saving health plans money. The bottom line is, we are all better off protecting medically stable patients’ preexisting prescriptions.”

This research follows IfPA’s October 2016 analysis of cost-motivated switching among Medicare Part B patients.  That research found similar connections between switching and higher long-term costs for patients with rheumatoid arthritis.

Method of Analysis

To explore the impact of cost-motivated switching, the Institute for Patient Access examined a subset of 2011-2015 data from Truven’s MarketScan® Commercial Claims and Encounters and Medicare Supplemental database, which includes information for 3.9 million people. Research was conducted for IfPA by The Moran Company.

For more details, read “Cost-Motivated Treatment Changes & Non-Medical Switching: Commercial Health Plans Analysis.”

Tags: , , , ,

Categorized in: