Insurance contracts shouldn’t jeopardize care
We must protect the relationship our health care heroes have with their patients
At a moment in our nation’s history when doctors in Pennsylvania and states across the country are giving everything they have to help patients battle the daunting effects of COVID- 19, those same doctors and many more may not have the final word in other critical health care decisions for our most vulnerable citizens.
In Pennsylvania and most other states across the country, there are no laws that prohibit health insurance companies from changing a patient’s coverage on a whim in the middle of the year — effectively blocking the treatments their doctor prescribed for them. This practice is commonly referred to as “non- medical switching,” and patients often don’t know it’s happened to them until they get to the pharmacy counter.
Health insurers can enact nonmedical switching on patients in a variety of ways — by raising out- of- pocket costs for a medication, moving a treatment to a higher drug tier, or removing coverage of a medication from a patient’s formulary altogether. But for many patients, the negative consequences of these decisions are the same no matter how it happens.
Patients who require medication to manage a chronic or complex disease can experience dangerous symptom flare- ups and even hospitalizations when they are forced to suddenly switch medications. Non- medical switching has financial ramifications too.
Patients may be forced to pay more than they can afford out of pocket for a treatment they depend on, and symptom flare- ups can force individuals to miss work, jeopardizing their ability to maintain a steady income.
Most important, non- medical switching creates a barrier between doctors and the patients they care for. Physicians are in the best position to make medical recommendations to help their patients. When an insurance company blocks access to a doctorrecommended drug in an attempt to serve their bottom line, it breaks the patient- physician relationship and the work physicians and patients put in together to find the right treatment plan.
Non- medical switching is most dangerous for the most- vulnerable citizens among us — the 40% of Americans living with chronic health conditions such as diabetes, arthritis or asthma. It is common for people living with a chronic health condition to spend years trying different medications before they find one that improves their health, and non- medical switching can take that medication away in the blink of an eye.
Every year, patients who depend on certain treatments carefully review their health insurance options to find a plan that allows them to access and afford their medication. And every year, in Pennsylvania and dozens of other states, there is no guarantee that health insurance companies will uphold their part of the contract.
The COVID- 19 pandemic has only intensified the challenges for many of the individuals who are most susceptible to these unfair coverage changes. According to the Centers for Disease Control and Prevention, “people of any age with certain underlying medical conditions are at increased risk for severe illness from COVID- 19.” That doesn’t even account for the economic burden and tough decisions many have had to make over the last several months.
Now more than ever, we must protect our families, friends and neighbors from this dangerous health insurance tactic. This fall, the Pennsylvania General Assembly can take action to end non- medical switching in our state by passing House Bill 853, a bill that is sponsored by the chair of the Pennsylvania House Majority Policy Committee, Rep. Donna Oberlander, R- Clarion.
In the last six months, we have seen health care professionals across the country risk their lives to help people infected with COVID- 19. Doctors are committed to a higher calling, and they alone should be responsible for working with patients to manage their medications.
The Pennsylvania General Assembly must hold insurance companies accountable to the contracts they sign and allow our health care heroes to make the best decisions for the patients they care for.