Regional View: Amid COVID-19, non-medical switching heightens health risks
Patients who suffer from chronic conditions perhaps know better than anyone the importance of accessing the proper treatments and medications prescribed by their doctors. But access to treatment is in jeopardy right now for me and millions of Minnesotans at a time when we must be doing everything to ensure our health care system is running smoothly.
Amid the uncertainty brought on by the COVID-19 pandemic, patients with chronic conditions deserve consistent access to their prescribed medications to minimize further health risk. While medical advancements have allowed many patients with chronic conditions — over a third of Minnesotans — to stabilize their condition, it can often take a series of trials with different treatments before finally finding what works best, without side effects. Therefore, once patients do finally identify a correct treatment, it is crucial they are able to maintain access to it.
As someone who has experienced the chronic pain of rheumatoid arthritis for over a decade, I rely on a very specific treatment to manage my condition. Though my health insurance has changed several times, I have deliberately selected plans, including my current plan — that cover infusion treatments that keep my condition in check.
That changed this spring when I received a letter from my insurance company informing me that it would no longer cover my rheumatoid arthritis treatments beginning April 1. It instead changed my treatment to a medicine known as a biosimilar. This is an all-too-common situation known as “non-medical switching,” which happens when a health insurer changes patients from a current medication to a therapeutic-equivalent medication by no longer covering the original medication or by taking some other action that makes the original medication unaffordable.
The FDA states that biosimilars, like the one I would be taking, are equally as safe and as effective as, and have no clinically meaningful differences from, the original treatment. Most patients will not experience adverse events from switching. However, some studies show that some patients may experience certain adverse events. This is not a risk I am willing to take. Nor am I comfortable having an insurer, instead of my doctor, make this decision on my behalf when I am locked into my health plan.
Rather than being required to inform patients before they commit to a full year of coverage, insurers can unexpectedly drop this decision at any point. This is what happened to me. When I received the letter from my insurance company, I still had eight months — about four or five infusions — until I could change to a different insurer which would cover my treatments.
My doctor, who knows my condition best, appealed to my insurance company and was flatly denied. I called the insurer to get more details and was only told that they “understand my frustrations,” but that it would not be reversing this decision.
Only after yet another letter to the company — just as the COVID-19 outbreak was becoming more serious — did it finally permit me to stay on my medication for the remainder of the year. This was good news in my case, but not every patient is as fortunate, and it should not have taken a pandemic for this decision to be reversed.
While non-medical switching — especially with no warning — should not be allowed, it is particularly problematic in these uncertain times. Insurers should be doing everything possible to help patients manage their conditions right now, rather than introducing new roadblocks to proper treatment and care. And they can start by reconsidering this potentially harmful non-medical switching policy.
Cathy Cheatham of Osseo, Minnesota, is a rheumatoid arthritis patient. She wrote this for the News Tribune.