Mental Health Disorders in the United States
Mental health disorders are conditions that are characterized by alterations in thinking, mood, and behavior. Such disorders vary in degree of severity, ranging from mild to moderate to severe. When not properly treated, mental health disorders can contribute to a host of problems, including issues in daily life, school, work, and relationships, and is the leading cause of disability in the U.S.
According to the Centers for Disease Control and Prevention (CDC), more than 50 percent of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime, and one in five Americans experience a mental illness in a given year. Additionally, one in 25 Americans lives with a serious mental illness, such as major depressive disorder, schizophrenia, or bipolar disorder.
The COVID-19 pandemic has exposed a growing mental health crisis in our country that has left many experiencing an increase in untreated depression symptoms, anxiety, and other mental health challenges. As Americans attempt to transition back to normal life, patients with mental health disorders need broad access to medically necessary treatments to manage their mental health and overall quality of life.
Defining Non-Medical Switching
Non-medical switching occurs when an insurer or pharmacy benefit manager (PBM) stops covering a medication, increases out-of-pocket costs for a treatment, or makes other negative changes after the plan year has begun. As a result, a stable patient can no longer afford his or her current medication and may be forced to switch to a different medication that is less effective for that particular patient. Health insurers and PBMs can engage in changes that result in non-medical switching at any point during the plan year. Yet, patients have no ability to change their plan.
Health insurers and PBMs often make coverage changes in an effort to increase their own profits. Oftentimes, that means the patient needs to switch to an older, less effective version of a drug. The insurer-preferred drug may not even be in the same class or category as the provider- prescribed drug.
Impact of Non-Medical Switching on Patients with Mental Health Disorders
Finding the right treatment for a patient with a mental health disorder is vital, and once the patient achieves stability, he or she must be able to remain on the effective medication. It can take several weeks for a patient to see improvement from treatments for mental health disorders, and not all treatments work the same way in each patient.
Non-medical switching is particularly harmful for patients with mental health disorders. If their remission is disrupted, they may face a higher risk of relapse, more rapid relapse, increased rate of recurrence of their mental health disorder, shorter course of well intervals, fewer symptom-free weeks, and increased risk of suicide. Switched patients also have had higher rates of hospitalizations and emergency room visits. Unfortunately, there is growing evidence that non-medical switching of patients with mental health disorders is becoming increasingly frequent.
