US insurers switch up to 70% of drugs

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A survey carried out by the Global Healthy Living Foundation (GHLF), a non-profit patient organisation, has shown that up to 70% of prescription medications are changed by health insurers, without doctors’ approval.


According to GHLF Executive Director, Mr Louis Tharp, “this disturbing finding is not a simple case of switching a brand-name drug for a generic one, a common and generally accepted practice used for many illnesses, and one GHLF supports.” The survey found that health insurance companies throughout the US are switching one brand-name drug for another to save money.

The survey found that if the drugs are identical, physicians generally have no objection, however, national medical groups have said most drugs are not identical, and switching can cause adverse reactions and poor recovery rates.

Patient relapses after switches

The survey also found instances of patients with chronic conditions who were responding well to a particular drug, but relapsed after being switched to a cheaper drug. Although health insurance companies can save a few pennies, if the patient’s chronic condition worsens, not just the patient but the entire economy suffers.

Fail-first practices

The foundation is conducting an additional national survey to measure the incidence of what are known as ‘fail-first practices’ where health insurers require a patient to fail on a cheaper drug before being considered for the original drug their physician has prescribed. Astoundingly, the data showed that some insurers require a patient to fail on a drug that is not approved by the FDA to treat the diagnosed condition before being allowed to take medication that has been FDA approved.

Mr Tharp said that “this is very worrying and we are working with other advocacy groups, State Insurance Commissioners, the FDA, and State Attorneys General to see what action can be taken to stop this dangerous practice.”

Switching to be banned

‘Switching’ is a practice that is starting to attract a lot of attention, and legislation is pending in New York, California and Missouri, USA, which would outlaw this practice. The US state of Louisiana already passed a law in 2009 prohibiting it.

Mr Tharp expects several more state legislatures to take up the issue in 2011 because “legislators realize that health insurers are practicing medicine without a state-issued medical license when they come between the physician and patient.”

Source: GHLF

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