Pennsylvania Health Advocates Attest to the Harms Caused by Mid-Year Formulary Changes


On February 18, 2020, the Pennsylvania House Consumer Affairs Committee held a hearing on HB 853, which would amend the state’s Unfair Insurance Practices Act to prohibit changes to health insurance policies in the middle of the plan year when an enrollee has already received treatment under that policy. During this hearing, health advocates testified about how they have been affected by mid-year formulary changes, including a man whose epileptic daughter suffered a seizure when her medication was changed. Representatives from the insurance industry claimed that these mid-year switches are necessary to respond to the fluctuating prices of medications and that appeals processes are in place to address situations where patients could be harmed by a medication switch. However, Dr. Marion Mass, a pediatrician, asserted that appeals only add to the growing amount of paperwork that health care providers are responsible for handling, which diminishes the amount of time they can spend caring for their patients.

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