The Colon Cancer Foundation, in partnership with 65 other organizations, has signed a memorandum urging New York Governor Kathy Hochul to sign S.4111/A4668 into law.

S.4111 Breslin/A.4668 Peoples-Stokes, which passed both the New York State Senate and the Assembly in April and May 2021, respectively, with bipartisan support, is a bill that prohibits mid-year formulary changes. (A formulary is a list of drugs that are covered by a prescription drug plan.) This in turn will prevent health plans from stopping coverage for a patient’s prescription drug in the middle of a coverage year, unless the switching is medically necessary—what is often referred to as non-medical switching.

Non-medical switching is described as changing a patient’s prescription medication to a clinically different non-generic alternative for non-clinical reasons, even if the patient is responding to his or her current drug. The reason for the switch is not based on a poor clinical response, treatment side effects, or non-adherence to treatment. The decision is often made by health plans to save costs.

A decision to replace a medication that a patient may be responding to may be particularly troublesome for patients with chronic disease or complex conditions. An online survey on non-medical switching among oncologists found:

  • 25% think it decreased medication effectiveness
  • 5% reported increased side effects
  • 5% indicated patients needed frequent or very frequent office visits
  • 5% said patients needed frequent or very frequent calls with pharmacies

The survey found that non-medical switching occurs across several specialties and that it can adversely affect patient care. Similar results were noted in a separate survey that sampled over a 1,000 physicians—physicians felt non-medical switching negatively impacted treatment efficacy, side effects, medication adherence, out-of-pocket costs, and medication errors.

Along with the adverse clinical impact of non-medical switching, there is the aspect of fairness. While consumers are bound by law to pay the premium, co-pays, deductibles, and honor the contract’s terms, insurance plans are not held to those same standards. Enrollees choose a certain plan based on their medical care and prescription needs. Being forced to switch in the middle of that contract is unfair on the patient.

We hope that Governor Hochul will support the bill and make it a law.

 

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