Chronically ill patients fearful of unreported drug switching by insurers, PBMs

Insurers and pharmacists should not switch effective therapies without patient and physician notification, according to a national survey of stabilized autoimmune patients that explored their perspectives on switching prescribed biological medicines.

The Global Healthy Living Foundation (GHLF), a nonprofit organization dedicated to improving the quality of life for people with chronic illness, administered survey questions through a web-based tool to 177 members of CreakyJoints, a GHLF-affiliated community of arthritis patients. These patients were currently stabilized on their biologic therapy and living in the United States. The survey questions were divided up according to the potential medical, financial and emotional impact from medication switching. Each of these sections had different multiple choice, yes or no, and/or free-form response fields for each question throughout the survey.

Tharp“Stabilized patients do not want to be switched from effective treatments for non-medical reasons and that both patients and their physician should be notified before any switch occurs,” said Louis Tharp, spokesman for GHLF. “Patients are deeply connected to their own care and have strong feelings on who should be able to play a role in their treatment decisions.

Related: How pharmacists can keep up with biosimilar approvals

The financial implications of formulary changes were found to have significant effects on patients. Even in light of potential cost increases, patients would prefer to stay on their current and effective medication rather than be forced to switch.”

Topline findings of the survey include:

• 98% of respondents support legislation that would specifically prohibit PBMs or pharmacists from switching a patient’s biologic medicine without patient or provider notification.

• 86% agreed only patients and doctors should have a say in which biologic medicine they are prescribed-compared with the 2% of respondents who said insurers should have a say in the matter.

• 95% of stabilized patients would be concerned that their disease would worsen if their biologic medicine was switched.

• 93% who have tried multiple biologics said they do not believe all biologics are equally effective.

It took 88% of patients more than 1 year to find the biologic treatment that worked for them, with 30% of respondents reporting to have waited at least 5 years to find an effective biologic for their condition;

68% of respondents have tried at least 1 other biologic medicine before finding their current, effective medication.

In a series of questions about effectiveness and side effects, patients surveyed said they would prefer to stay on their current biologic, even if there were a 20% increase in costs, than switch to a cheaper drug that had either less effectiveness or more side effects.

“It’s clear that patients, who have often spent years working with their physician to stabilize their condition, want to remain on the medication that works for them,” Tharp said. “Having effective therapies switched can inflict significant medical and emotional tolls on stabilized patients, and managed care executives should take this into consideration when implementing policies.

Related: [BLOG]: Biosimilar confusion and insights

“Not all biologics are effective for every patient; it takes time for patients to find the right biologic and patients have genuine fears about being forced to switch for non-medical reasons,” he added.

While it’s best to ensure stabilized patients are not switched for non-medical reasons, if a patient is switched, the patient and physician must be notified beforehand, Thorp advised.

“Further, if patient well-being is considered, managed care executives should support legislation that would prohibit an insurance company from removing biologics used to treat autoimmune diseases from their formulary without offering a ‘grandfathering’ option for stabilized patients,” he said.

Read next: [BLOG]: FDA approves first biosimilar in US, may lead to easier access to biologic medications for patients