Iowa health plans don’t provide stable care for chronic illness

We all know someone — a friend, family member, maybe even yourself — who has an uncurable health condition. If untreated, these conditions can cause major disruptions to daily life or become debilitating. Often though, these conditions are manageable with proper treatment. As a rheumatologist, I work with Iowans to find treatments that work for conditions like rheumatoid arthritis and lupus. And I see firsthand what happens when treatments that work are taken away by patients’ health plans.

Patients often struggle for years to identify an appropriate treatment for their chronic conditions. Seemingly endless scans, tests, labs and conversations with their provider can make a patient feel hopeless; but when they are able to identify the treatment that manages their condition, that all becomes worth it. Unfortunately, insurers often meddle in this process.

I personally witnessed a patient of mine lose access to a prescription that she had been medically stable on for years. She was effectively priced out by her health plan and could no longer afford the increased out of pocket costs. This loss of access to her medication put her in a tailspin, resulting in a lengthy hospital stay to stabilize her condition. In the end, she lost her life due to a decision made about her care by an insurer trying to save a few dollars.

As a rheumatologist, my patients have complex care needs and rely on stability in their treatments to manage their conditions. Providers may spend multiple years of trial and error finding a treatment regimen that properly manages their condition. The resulting course of treatment must carefully balance each patient’s unique medical history, co-morbid conditions, and potential side-effects. Treatment plans are carefully chosen and tenuous. Even slight deviations in treatment and variations between drugs, even those that are similar, can cause serious adverse reactions. All this hard work and struggle to find the right treatment is immediately undone when health plans decide to prioritize their profits over the well-being of their members.

Non-medical switching occurs when health plans force a stable patient to switch from their effective medication by making the patient’s current medication financially unreachable. Health plans accomplish this by removing the drug from their formulary, moving the drug to a more restrictive formulary tier, or using other prevailing means to increase the patient’s out-of-pocket costs and decrease their predicted profit losses.

When patients can’t afford their medication, there’s more than a financial cost. This is true for all chronic conditions, such as diabetes, cancer, epilepsy, and mental illness. Non-medical switching can cause patients to backslide, resulting in the reemergence of symptoms or worsening of condition. Aside from needless suffering, the resulting disease progression can be irreversible, life threatening, and cause the patient’s original treatment to lose effectiveness. It cannot be assumed that a treatment that works for one patient will work for each patient. These one-size fits all decisions disrupt clinicians’ ability to use their medical expertise in concert with their patient’s needs.

I am not unconcerned with the cost of pharmaceuticals in the United States. However, non-medical switching is a poor way to control costs and leads to larger follow-up costs that swamp any upfront savings. Physicians, pharmacists and other health care administrators have reported that non-medical switching increases administrative time, increases side effects or new unforeseen effects, and increases downstream costs.

Iowa’s legislators can put an end to non-medical switching this year. Preventing this practice through legislation would, without a doubt, save patient lives. However, providers, patients and advocates face a deeply entrenched industry on these issues. Ensuring that legislators are educated and aware of the harm of non-medical switching is critically important. Please contact your representative and let them know you support legislation that will put an end to non-medical switching.

Dr. Michael Brooks is a rheumatologist from the Cedar Rapids area. Outside of caring for his patients, he’s an active board member for the Rheumatology Association of Iowa.

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