AUGUSTA — Health care decisions about medication should be made by doctors and their patients, not by health plans.

Thousands of Mainers live with chronic conditions like diabetes, arthritis, Crohn’s disease or hypertension that require them to take daily medication. Many others use medication to help manage cancer, chronic pain or mental illness.

For these folks and many more, finding the right medicine often means trying several options before discovering the most effective treatment with the fewest and most manageable side effects. Sometimes this process takes months, and it can be difficult for patients and their families – but it’s critical. Once they find the regimen that works and are stabilized, Maine patients should be able to continue that course of treatment. Changing medication unnecessarily can cause major health problems and trigger other, non-medication-related costs.

Especially for those with chronic illness, disrupting treatment of a well-managed condition can cause uncomfortable or even debilitating symptoms to re-emerge or worsen. It can lead to struggles with daily life, disrupt the ability to care for oneself and one’s family and interfere with driving and employment.

But this is precisely what many Mainers face when they fall victim to nonmedical switching.

Nonmedical switching occurs when health plans compel a stable person to stop taking the medication prescribed by their health care provider and, instead, take a less expensive medication for nonmedical reasons without consulting the patient’s health care provider. Patients may be required to change to a medication other than the one prescribed by their doctor because of requirements within their plan. This policy is also known as “formulary-driven switching,” because it is based on the plan’s formulary – that is, the list of prescription medications that the plan will cover – rather than a physician’s reasoning for prescribing the original medication or the potential medical outcomes for the patient of a change in course of therapy.

One could assume that switching to a cheaper medication would lead to lower health care costs for the patient and the health care system. However, recent research and analysis of national data from the nonprofit Institute for Patient Access show this theory to be unfounded. Patient destabilization caused by mandated switching to a less expensive drug often leads to increased, associated nondrug expenses in the months following.

Mainers forced to switch medications may experience negative side effects or see their condition worsen because of reduced drug efficacy, leading to the need for additional trips to the doctor for testing, monitoring and to adjust dosing. Because of the highly addictive nature of opioids, the risk to a person stabilized on a non-addictive pain management regimen forced to switch to cheaper, more addictive opioids, is great. With the ravaging impact of opioid addiction on too many Maine lives and communities, we should do everything possible to keep people stabilized on less or even non-addictive alternatives.

At a time when, here in Maine, policymakers and medical providers are trying to reduce opioid prescriptions, nonmedical switching makes that objective more difficult. That is not acceptable.

Mainers deserve stability and predictability in their health care treatment. Our goal is to stop this practice and to ensure Mainers have ongoing coverage of their medication for as long as they remain with their health plan. We all want to control health care costs, but forcing people to change medicine with the hope of saving a few dollars doesn’t work.

That is why we’ve proposed legislation to help Mainers retain access to the pharmaceutical benefits that keep them stable. We hope our colleagues in the Legislature will join our bipartisan effort and vote “yes” this legislative session.

Nonmedical switching happens in Maine. And it needs to stop.

 

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