To the editor:
The Pacers can’t unexpectedly move your season tickets from the lower level to the upper level if you’ve paid for specific seats and games. Similarly, when we annually sign up for health insurance, there is an expectation that our services, doctors and available medications will stay the same all year long. Unfortunately, many people in Indiana, like me, are victims of the old switcheroo, and we aren’t getting the health insurance we’ve paid for.
For forty years, it was a pleasure and privilege to teach second- and third-graders in Indianapolis. But eventually, I had to retire early, at the age of 62, because of relentless arthritis pain in my knees and back that limited my ability to do some of the physical aspects of my job, such as bending down over my students’ desks to help them with their work. My osteoarthritis eventually led to several joint replacement surgeries, and I rely on a cane to walk.
After trying several kinds of medicines, my doctor prescribed a medication that combines a pain reliever and gastric protector in one pill. It was a relief to find something that worked and did not cause painful side effects. I used the medication for years, which is why I was caught completely off-guard when I was asked to stop taking it by my health insurer for non-medical reasons.
It started when I received a letter saying that I needed to switch from my preferred medication to a regimen that included the same ingredients but which is delivered in separate pills. That may sound like a small change and maybe worth it to reduce costs. However, my doctor told me not to switch because he believed that the combination pill worked better. Plus, data shows that patients take their medicines more compliantly when they are packaged conveniently.
Despite his advice, I initially tried the medications separately but experienced no relief from symptoms, so I switched back to what my doctor originally ordered and took the combination pill. Eventually, regardless of our preferences, the payer stopped covering my medication, and I couldn’t afford to pay for it without my insurance covering some of the costs. When it came time to sign up for another year of health insurance, I also couldn’t find a new insurance provider that would cover the medication.
My story is an example of non-medical switching, or when a health insurance provider pressures patients to switch their prescription medications for non-medical reasons by making it difficult or impossible to access their medications. Payers can restrict access by increasing out-of-pocket costs for certain drugs, removing a medicine from their previously published formulary, or requiring additional paperwork that delays filling a prescription.
According to a new online survey conducted by the Global Healthy Living Foundation on behalf of the Indiana Stable Patient Protection Coalition, 69 percent of chronic-disease patients in Indiana were forced to switch to a different medication for non-medical reasons after their insurance coverage was changed in the middle of a plan year. Seventy-eight percent reported that they found their new medication to be less effective. Fifty-seven percent reported side effects with the new medication; of those, 93 percent reported that the side effects were worse. And of those who experienced side effects, 46 percent had to see a doctor, go to the emergency room, or both as a result of the complications.
Non-medical switching is unfair to patients who believe they are entering into a defined contract, and it is dangerous. Chronic disease patients rely on stable access to medications, and it puts a person’s health at risk when their prescriptions are delayed or denied without just cause.
This year, the Indiana General Assembly will consider legislation that will hold health insurance companies accountable for providing access to the medications listed in the formulary at the time that the contract is signed. Patients and physicians ought to take the lead in medical decisions, not insurance companies. I urge resident of Indiana to support legislation being championed by Senator Liz Brown. To learn more about how to talk to your representative about this issue visit www.50statenetwork.org
Kay Wiseman
Bargersville
