Kari Uusinarkaus

When patients find a medication that works, they shouldn’t be forced off of it by insurance companies focused on profits instead of health outcomes. Yet I see this practice, dubbed “non-medical switching,” far too often in my practice.

Sometimes insurers eliminate coverage for the patient’s medication. Sometimes they increase the co-pay to unaffordable levels. Regardless of how they force the switch, however, it impacts patients and harms their health.

To illustrate the point, I’ll share the story of a current patient. Let’s call her Jane.

When Jane first came to me, she was 63-years-old, overweight, and struggling with diabetes and high blood pressure. Jane committed to making a change, and over the course of a year lost more than 50 pounds. Through trial and error, we found a combination of medicines that managed her symptoms. Her A1C level, a common test for diabetes and pre-diabetes, dropped to 7.1, very near the ideal control level.

Jane had achieved the sort of changes that physicians like me strive for every day. She had dramatically reduced her risk of falling victim to cardiovascular disease.

But then Jane’s insurance coverage changed. Her insurance carrier moved her off the medications that had allowed her so much progress and onto a mixed form of insulin that needs to be dosed twice daily instead. She started regaining weight, and her A1C climbed up again. Jane’s multiple risk factors for cardiovascular disease, the factors she had worked so hard to control, had returned.

To be clear, the prescription medications that had helped Jane were supported by data and science. They were FDA approved for her conditions and recognized as providing positive outcomes for cardiovascular patients. One was from a class of drugs called SGLT2 inhibitors and the other a GLP1 RA. Both can help reduce heart failure and avoid expensive emergency department visits and hospital admissions.

Yet her carrier made the shortsighted decision to fatten their profit margin by opting instead for drugs that cost them less. Nevermind that their profit came at my patient’s expense. It’s also likely that paying for Jane’s original medication could have saved them in the long run by preventing higher-cost complications down the line. According to the CDC, Colorado ranks #1 in the country as the healthiest state – which begs the question, why won’t Colorado insurers help our patients who need coverage the most?

The fact that health insurers are making treatment decisions for me — and for my patients — reflects a health care system that is seriously out of whack. Non-medical switching harms the fundamental patient-physician relationship, and it ignores the hard work that patients and their providers undertake to find a treatment strategy that really works.

Patients and their physicians should be free to make their own decisions about medication and treatment. Non-medical switching is a dangerous, counterproductive strategy that puts profits squarely ahead of patient health. It’s time that insurers do better by the Coloradans they serve.

Kari Uusinarkaus, MD, is a primary care provider based in Colorado Springs.

Kari Uusinarkaus, MD, is a primary care provider based in Colorado Springs.

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