Cost-Motivated Treatment Changes

Cost-Motivated Treatment Changes: Implications for Non-Medical Switching – from the Institue for patient access (IFPA)

In the face of rising health care costs, some commercial health plans are attempting to switch stable patients to a less expensive medication in hopes of lowering costs.

Known as “non-medical switching,” these changes can result from formulary changes that eliminate coverage for a patient’s medication or increase the level of required cost sharing.  

Non-medical switching can also occur as the result of insurer incentives or health plans’ decision to limit or reject copay coupons that make treatments affordable for patients.

Definition: Nonmedical switching – Compelling a stable patient to change medications for reasons unrelated to his or her health; often driven by health plan design or policies.

The Institute for Patient Access began exploring the impact of cost-motivated treatment changes using Medicare Part B data

for now, IfPA’s data suggest two critical concepts:

1.)  Keeping patients stable on their medication can help to control overall costs for some patient populations.

2.)  Changing treatments based on cost alone is not a choice that patients and insurers should make – or impose – lightly.

The Institute for Patient Access is a physician-led nonprofit 501(c)(3) research organization promoting the benefits of the physician-patient relationship in the provision of quality healthcare. To learn more visit


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