Non-Medical Switching Pushes Patients to the Brink

May 24, 2022

A staggering 40% of mental health patients who were forced to switch a medication prescribed by their doctor with one mandated by their insurer found that the mandated drug did not work as well.

This is just one of many disheartening findings from a recent survey about the harmful effects of non-medical switching. The practice is defined by insurers forcing stable patients to change their medication based on cost, not medical necessity. The Alliance for Mental Health Care Access conducted the survey to gain a fuller understanding of mental health patients’ experiences with the controversial practice.

Patients Experience Harmful Side Effects

Nearly one in four patients surveyed suffered negative side effects from pausing, changing or stopping their medication, according to the summary report. “The Dangers of Non-Medical Switching for Mental Health Patients” noted of patients who were subjected to the practice:

  • 60% felt increased anxiety or depression
  • 40% experienced stress, confusion and frustration.

Patients also reported weight gain, missed work or school and reduced interest in social activities. These and other side effects not only reduce patients’ quality of life, but they can have a devastating effect on a patient population that is already at increased risk of not taking their medication as prescribed, homelessness, cardiometabolic diseases and suicide.

“I found one medication that works after almost 20 years of treatment, hospitalizations and suicide attempts,” commented one patient in the survey. “(Now) it’s not covered by insurance.”

Insurers Force Drastic Measures

Another way insurers compel patients to change their medication is by raising patients’ costs. A prohibitively high out-of-pocket price can drive patients to switch to the insurer’s preferred medication.

Among patients surveyed:

  • 30% skipped doses to make their supply last
  • 28% never filled their prescriptions
  • 20% stopped taking medication altogether.

Without access to the right treatment, patients’ mental health can decline.

The Importance of Stability

As of 2020, one in five Americans were living with a mental health disorder. It’s widely believed that number increased during the COVID-19 pandemic.

Fortunately, years of research have created effective treatments for many of the most common conditions including depression and anxiety disorders, as well as serious psychiatric disorders like schizophrenia. Once patients are stable on a treatment regimen, the last thing they need is their insurer undercutting their progress for the sake of cost savings.

As America observes Mental Health Awareness Month this May, everyone should be aware of the toll utilization management barriers like non-medical switching are taking on those living with mental health conditions. When doctors’ decisions on medications are overruled by insurers, patients suffer.

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