Deadly Swap: PBMs, Health Plan Drug Switching To Save Money

  • by: Robert Goldberg |
  • 01/09/2017

Sometimes PBMs and health insurers don't even bother with step therapy or high cost-sharing to limit access to drugs that give them the biggest rebates.

Now they are just switching what drugs they cover without telling consumers. 

Swapping drugs to save money is unsafe and unhealthy:

Patients who were switched to another SSRI for non-medical reasons after being stabilized on escitalopram used more resources and had higher health care costs within 3 months of switching than patients who did not switch.

Non-medical switching of drugs for patients treated for heart conditions, diabetes, rheumatoid arthritis, ulcers, menopause, and pain "was more often associated with negative or neutral effects than positive effects on an array of important outcomes. Among patients with stable/well-controlled disease, non-medical switching was associated with mostly negative effects."

 Switching may expose heart patients to a higher risk of therapy discontinuation or substitution.

This isn't just a case of switching from a brand to generic or from one brand to another.  Switching from one generic to another can cause problems:

After switching their generic phenytoin, 33 out of 80 patients with epilepsy (41%) suffered from increasing seizure events. The number of medical visits for acute seizure significantly increased in the post-interchange period. 

These are just a few of the studies that associate when insurers and PBMs switch drugs to save money, they can hurt patients.

Incredibly,  the Medicare part B study was going to non-medically switch the cancer drugs seniors gets without telling them.   Proponents failed to acknowledge the risks of such a study.  In this content, it should be pointed out that ICER's decision to limit access to new drugs based on how it affects the bottom line of health plans is non medical drug switching writ large.   

It's not enough to be against step therapy.   All that will do is increase the amount of dangerous non-medical drug switching taking place in the dead of night, without notifying patients or worrying about whether such a switch will do more harm than good.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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