Aimed Alliance Sends Cautionary Letter to Blue Cross Blue Shield Regarding Nonmedical Switching


On June 4, 2019, Aimed Alliance sent a letter to the Blue Cross Blue Shield Association responding to the insurer’s decision on September 26, 2018 to exclude several pancreatic enzyme replacement therapies (PERTs) from coverage in health plans offered to federal employees. Individuals with exocrine pancreatic insufficiency (EPI) rely on PERTs to replace the pancreatic enzymes that their bodies do not naturally produce to help break down nutrients in food. EPI is often a condition that is present in individuals with cystic fibrosis, chronic pancreatitis, and other serious illnesses.


Aimed Alliance’s letter cautioned against the Association’s decision because it could result in nonmedical switching of patients who are currently stable on the PERTs that will now be excluded from coverage. Forcing a patient to switch medications can disrupt their continuity of care, contribute to negative health outcomes, and increased costs for the health system. Aimed Alliance reiterated that PERTs are not interchangeable, which means that patients need access to a broad selection of options to ensure that they are able to access a medication that can successfully manage their condition. For example, if a patient with EPI is switched to a PERT that does not adequately manage his or her condition, the symptoms of the condition could become exacerbated and could progress into more serious health conditions, including abdominal pain, intestinal obstruction, and increased incidence of steatorrhea and rectal prolapse.


Read our letter to learn more.


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