Congratulations to Reps. Bob Foley and Heather Sanborn in sponsoring legislation to prevent switching of medications to match insurance company’s drug formularies (“Doctors, not insurers, should prescribe Mainers’ medications and treatment,” March 9).

I would like to offer a couple observations from ground level.

First, this practice is not in any way new. It has been going on for 15 to 20 years. As a physician who tried to use lower-cost, effective medications, this was frustrating. Being forced to choose between a higher co-pay for the drug on which we had established an effective regimen was at times dangerous.

Why would a cheaper drug be in a more expensive tier for the patient? This had to do with contracts a drug management company made with pharmaceutical companies.

The choices for switching could make no sense. Alternative drugs proposed by medication “managers” might not be designed for the same purpose, or be in the same class of medication. They might interact adversely with other medications. These options led to increased complexity (risk) in transitioning.

Second, this is not about government medicine or ObamaCare. It is about private insurance companies contracting with private medication management companies who contract with pharmaceutical companies. Profits must be generated at each step. These contracts can shift year to year, forcing transitions to other medications for no medical reason.


My sense is that this complex contracting hides the impact of adverse consequences to patients of drug switching from the pharmaceutical companies. It is possible they have no clue how much they are paying for adverse consequences related to these practices.

Patient safety requires an ongoing relationship with providers. Patients with multiple chronic conditions require extremely careful management and thoughtful, gentle, individualized titration of medications.

Patient safety has to be key and this legislative approach is a step in the right direction.

Roger Renfrew, M.D.


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