Prevent Non-Medical Switching by Plans

TMA Written Testimony on House Bill 2099

House Insurance Committee
House Bill 2099 by Rep. Stan Lambert

March 26, 2019

Nonmedical switching refers to a change in a stable patient’s medication for reasons other than improving the patient’s health. The patient’s insurance initiates the change without considering the patient’s specific medical needs.

The issue of nonmedical switching is one that affects many Texans, especially those with chronic illnesses that require daily medication(s). These patients rely on their medications to be productive members of society. Access to their medications helps them avoid trips to the emergency department and helps protect them from having to obtain other, more costly forms of care.  

Insurance companies often use nonmedical switching to force patients to use a less expensive medication. The change to the patient’s drug formulary typically occurs at the end of the health plan policy year. At that time medications may be removed from the formulary and replaced with generic or less expensive medications. While a medication may be “therapeutically equivalent” to the patient’s current medication, it may create adverse side effects or be a medication the patient has tried unsuccessfully to take in the past.  

House Bill 2099 by Rep. Stan Lambert provides a reasonable, individualist approach. On a patient-by-patient basis, a health plan is prohibited from switching a patient off a medication he or she is stable on when the patient’s health plan is renewed at the end of the health plan policy year. This bill does not require a health plan to change its entire formulary but instead requires modification of the formulary on a patient-by-patient basis.  

Most importantly, HB 2099 protects the sanctity of the patient-physician relationship.  Physicians must be able to use their prescription pad for just that – writing medically appropriate and necessary prescriptions. Health plans should not use the physician’s prescription pad as a “suggestion” pad. Physicians must be allowed to treat their patients in a manner that is best for the patient (not the insurer). As a family physician, I am frustrated on a daily basis by health plans overriding my medical judgment and interrupting my patient’s medication treatment plan solely to increase their bottom line. 

We appreciate Chairman Eddie Lucio III and the House Insurance Committee for their attention to this issue and Representative Stan Lambert for carrying this important, patient-centric legislation. Please feel free to reach out to the Texas Medical Association’s staff for any needed follow-up or additional information.  

Douglas Curran, MD
Texas Medical Association 

Last Updated On

March 25, 2019

Originally Published On

March 25, 2019

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