Practice of ‘switching’ medication can be unhealthy

found that 69 percent of stable patients subject to nonmedical switching had adverse reactions as a result of the change. And contrary to popular belief, switching to lower-cost treatments may not always lead to long-term cost savings since conditions for chronically ill patients can worsen and require additional, often expensive, treatment. Doctors, pharmacists and other health care administrators have reported that nonmedical switching increases administrative time, leads to side effects and increases overall costs to plans and patients.

Some large health care systems in Ohio have begun implementing policies that force patients to switch from prescribed biologics — large-molecule drugs produced from living organisms such as plants or animal cells — to lower-cost alternatives called “biosimilars.” As the name suggests, biosimilars are similar to biologic drugs but variability in the manufacturing process does not make them exact copies.

Aimed Alliance firmly supports the development, approval and use of biosimilars. However, we also strongly believe that doctors — not PBMs, insurers or health care systems — are best qualified to determine which treatments, whether biologics or biosimilars, will work best for their patients, based on each patient’s needs.

Nonmedical switching can affect any patient, but patients with complex conditions (e.g., diabetes, rheumatoid arthritis and psoriasis) that require precise, tailored treatments — and for which even the slightest variation might alter a treatment’s effectiveness or results — are at especially high risk of adverse reactions and outcomes.

For all patients, but especially those with complex conditions, doctors consider a patient’s age, life activities, condition progression and many more factors when prescribing an appropriate treatment. Because these conditions can last a lifetime, long-term stability is important and so are precise medications. Among patients treated for diabetes, for instance, studies have found a difference in the medical outcomes of those treated with biologics and those treated with biosimilar insulin products. As such, the FDA has warned that changing insulin products should never be done without the consent of a patient and his or her prescriber.

Not only does nonmedical switching put patients at risk, it can also create a conflict of interest for health care practitioners. Health care practitioners take oaths to put patients first and to provide them with the best possible treatment. Yet, as employees of health care systems, they are also influenced by employer directives, including those focused on profit maximization rather than patient care. Such directives can put these professionals in the impossible position of being forced to choose between violating an employer’s orders or a solemn duty and patients’ trust.

When health care systems implement policies that force stable patients to change from effective medications, they create physical, mental and financial distress for already vulnerable individuals. Ohioans should not be left to fend for themselves in opposing policies that place their health at risk. Ohio lawmakers should pass legislation to prohibit or limit nonmedical switching and to address the increasing use of nonmedical switching by health insurers, PBMs and health care systems.

Without swift action, conditions for Ohio’s health care consumers and professionals are likely to worsen.