Nonmedical switching occurs when an insurer or pharmacy benefit manager requires a stable patient to switch from his or her current, effective medication to a less costly, alternative (but not generic) drug by removing the medication from the formulary list, moving a drug to a higher cost tier, or increasing the out-of-pocket costs owed. This switch occurs after the plan year has already begun or during the plan year’s renewal period. Nonmedical switching can cause adverse events, such as hospitalization or missed work days. Oftentimes, a patient will have to switch more than once to find stability again.
States have begun to introduce legislation to address nonmedical switching. Please click on the map below for information about legislation introduced this session.