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Non-Medical Switching

What is it? 

Non-Medical, or Formulary-Driven, Switching refers to a policy used by insurers to limit prescription drug coverage to the less expensive medications. It can be used to alter a patient’s medication to the less expensive option during the patient's current health plan year without any physician or patient consultation.

Why is it important?

Insurers maintain the argument that formulary-driven switching is utilized to benefit patients by providing them with similar alternative drugs at a fraction of the cost. However, in reality, this policy can be extremely detrimental to a patient’s health and their wallets. Without any restrictions, insurers are able to change a patient’s coverage and fundamentally alter the agreed-upon contract. This means that a patient on a prescribed and effective medication can have their treatment disrupted at any time. Because there is no guarantee that a similar alternative will produce the same effective result, patients are exposed to potentially adverse health effects caused by the switch in medication. This, in turn, leads to exponentially higher costs as well.

What is CSRO doing about it?

Switching a patient’s coverage without the consultation of their physicians and the patients themselves is fundamentally irresponsible. These switches take stable patients and force them into unnecessary health risks and economic burdens. Insurers must be required to provide complete transparency regarding coverage and whether or not a patient will be required to make a switch before enrolling in their health plan. Furthermore, patients who are already receiving stable and effective treatment should never be forced to deviate to an alternative medication unless their physician deems it necessary for medical reasons.

CSRO is a steering member of the KeepMyRx Coalition, which works to support non-medical switching legislation in the states. We have created local coalitions in partnership with our state societies to support legislation that CSRO has taken through the legislative process. This includes action providing committee testimony, submitting letters of support, attending advocacy days, placing op-eds and social media posts, and sending out action alerts for members to send their own letters to elected officials.

What can YOU do about it?

Visit our Legislative Map Tool to read about current non-medical switching laws or legislation in your state. You can send letters in support of pending legislation and find educational materials.