Formulary-Driven Switching is a policy designed by drug plans to limit prescription coverage to less expensive medications. Under Formulary-Driven Switching, patients may be required to use a medication other than the one they are prescribed, or may be switched off an effective current medication because of requirements within the coverage plan.
Where We Stand
- Switching stable patients for non-medical reasons places patients at unnecessary risk and increases healthcare costs.
- Physicians and patients should have input about a patient’s course of therapy.
- Insurers need to be fully transparent about what medications are covered and if a patient will be required to make a switch before choosing their coverage.
- Patients who are medically stable on a course of treatment should be allowed to continue unless there is a medical reason to change their treatment.
This is sometimes referred to as Non-medical Switching because the change in medication is determined by the plan formulary without any consideration of the medical repercussions or a physician’s knowledge and reasoning behind the selection of the original prescription medication.
Formulary-Driven Switching is based on the assumption that cost savings can be achieved with drugs from the same therapeutic class. Drugs in these classes generally have some level of medical interchangeability because their mechanisms of action are similar, even though the chemical makeup of the individual drugs are different.
Numerous studies have found this basic principal to be false in terms of both quality of care and actual cost savings as reduced effectiveness of the switched medication or the effects of medication stability disruption can cause adverse reactions and loss of effectiveness, both of which lead to higher cost patient outcomes.