What Is Non-Medical Switching? 

Non-medical switching occurs when a person has their prescription medication switched by their health plan for reasons other than their medical needs as determined by their physician.  Often implemented as a cost-saving measure for the health plan, non-medical switching happens when patients are priced out of their chosen medication by:

  • Assigning the medication to a higher co-pay
  • Increasing patients' out-of-pocket requirements
  • Reducing the maximum plan coverage amount for prescription medication
  • Eliminating coverage for certain medications altogether

When stable patients are kicked off the medications that work for them they risk disease progression, new or worsening side effects, more frequent visits to their doctor, loss of daily function and possibly even hospitalization.

The Texas Coalition for Stable Patients seeks:

  • To pass legislation that supports patients by further preventing health insurance plans from making benefit, coverage, utilization management or access switches that result in negative impact on a patient’s health.
  • To preserve the relationship between providers and patients to make treatment decisions and to ensure that changes to treatment plans are made for health reasons and not for non-medical reasons or without medical rationale.