Nevadans who have chronic illnesses rely on the medications that stabilize their conditions and are placed at risk when their insurance companies make non-medical formulary switches to the medications they cover simply to lower costs. These changes are made by insurance companies to the medications that they cover regardless of whether the changes are medically appropriate for the patients. Some patients may be switched to medications that their bodies simply do not respond to as well and that are not as effective.

What Are Non-medical Formulary Switches?

Non-medical formulary switches are changes insurance companies make so they cover medications they can obtain at the lowest price. Insurance companies negotiate drug prices with drug makers for different medications. If the insurance companies decide that the prices for certain drugs are too high, they will drop the coverage for those medications and instead cover different, cheaper drugs for the same conditions.

The Problem with Non-medical Formulary Switches

Non-medical formulary switches can be problematic for patients. For some chronic conditions, it can take some time for doctors to find drugs that work for their patients’ symptoms. Once a person’s body has become accustomed to a specific medication and is responding well, it can be difficult to adjust to a new medication. A different medication may also not work as well or have the same delivery method or the same ingredients.

Patients whose medications are suddenly changed without the input of their doctors may be placed at risk. The new medication may not work to control the symptoms of their diseases, which can cause them to suffer emergency medical issues that require hospitalization.

Asthma is a good example of this problem. Finding the right medication to help control the symptoms of asthma in children can be difficult. When insurance companies switch the asthma medications they will cover, the patients may suffer severe symptoms and worse health outcomes. People who are unaware that their medications have been dropped from coverage may find themselves unable to afford the drugs that they need and might have to go without medication for short periods.

What Can Be Done?

Nevada has passed rules disallowing insurance companies from making non-medical formulary changes during the middle of the year when people are locked into their plans. More regulations are needed to lower drug prices and to prevent companies from making changes that are unsupported by patients’ doctors.