This occurs when a medically stable patient is switched off of his medication for non-medical reasons by an insurer during the middle of a contract year and the insurer requires its members to change over to a new drug instead of keeping them on the drugs that their doctors have prescribed. Numerous studies have shown this practice to be highly detrimental in terms of both quality of care and actual cost savings as reduced effectiveness of the switched medication or the effects of medication stability disruption can cause adverse reactions and loss of effectiveness, both of which lead to higher cost and poorer patient outcomes.
COGI Policy Priority:
Patients who are medically stable of a course of treatment should be allowed to continue unless there is a medical reason to change their treatment. We oppose the switching of stable patients from treatment courses for non-medically necessary reasons, as it is both unethical and violates the standard of care. All treatment decisions should remain between the patient and prescribing provider.
