Nonmedical Switching

Nonmedical switching occurs when a health insurer requires a stable patient to switch from his or her current, effective medication to an alternative drug by excluding the original medication from coverage, elevating the drug to a higher cost tier, or otherwise limiting access to a treatment or increasing the patient’s out-of-pocket costs. Forcing a patient to switch treatments can upset his or her medication stability, which can expose the patient to avoidable negative health outcomes and increased costs for both the insurer and the patient.