News & Advocacy
Non-Switching Legislation (HB 153) Update
posted: June 1, 2021
Ohio’s non-medical switching bill (HB 153) had a proponent hearing yesterday. Big thank you to Dr. Ott for coming to Columbus to testify.
View the Hearing
Dr. Ott’s testimony starts around minute 49.
Below is a recap article that ran in the statehouse news last night.
Providers Blast “Medication Switching” Practice
Several medical professionals on Wednesday backed a measure designed to prevent insurance companies from changing prescription formularies mid-year for non-medical reasons.
The legislation (HB 153) would prohibit insurers from moving pharmaceuticals to a more restrictive tier or removing it from a formulary, except when directed to do so by the U.S. Food and Drug Administration due to health and safety concerns or because a drug is no longer available, except at the end of a plan year.
Dr. Stephanie Ott, testifying on behalf of the Ohio Association of Rheumatology, told members of the House Insurance TrackCommittee that the practice of “medication switching” is based on the presumption that cost savings can be had.
“However, numerous studies have found this basic principle to be false 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 patient outcomes," she said.
Dr. Ralph Gruppo testified on behalf of the Ohio Bleeding Disorders Council. He told the panel that he recently experienced “medication switching," which resulted in high prescription drug prices.
“This strikes me as basically unfair," he said. “I don’t dispute the necessity of insurance companies needing to readjust the drug tier for their formulary drugs, but to do this one month after I selected which drug plan to participate in based on information which at the time was current seems patently disingenuous.”
Gary Dougherty, director of state government affairs at the American Diabetes Association, said that such changes can disrupt continuity of care and jeopardize health.
Dr. Melissa Piliang, president of the Ohio Dermatological Association, said in written proponent testimony that abrupt medication changes can cause serious side effects and worsen conditions being treated.
“The sickest patients are the ones hardest hit. Complex health conditions can already be tricky to manage, but non-medical switching represents an additional barrier to patient access to life-saving medications. Patients who select a health plan based on specific medication coverage needs should have assurance that the plan will maintain consistent coverage for those medications,” she wrote.
“It is fundamentally unfair and harmful to force changes to a patient’s treatment midyear when the patient believes they are contractually assured access to the medication they are stable on, and without regard for how this change may jeopardize the patient’s health.”
Dr. Brian Evans, president of the Ohio Psychiatric Physicians Association, said finding the right medication to treat a mental health condition can be difficult and sometimes takes months or even years.
“By forcing patients to switch from a current medication to one that costs the health plan or PBM less, the health plan issuer causes avoidable suffering to the patient and can ultimately negate much of the potential savings,” he wrote.
“The practice of non-medical switching can cause dangerous and harmful disruptions in continuity of care, resulting in adverse events that may require hospitalizations, visits to the emergency room, or other critical care. It may also cause resurgences of symptoms that were previously well-controlled and managed, undoing progress done with treatment of the patient’s condition.”
The panel also received written proponent testimony from representatives of The Ohio Hematology Oncology Society, the Ohio State Medical Association, UC Health and the Columbus Medical Association.