Abstract
BackgroundPhysicians are in an ideal position to describe the impact of medication non-medical switching (switching commonly due to formulary changes by insurer for reasons unrelated to patient health) on their practice dynamics and patient care. We sought to examine physicians’ openness to requests for non-medical switching and their experiences and opinions regarding the impact of non-medical switching on their practice, staff and patients.MethodsAn online survey of randomly-sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. The impact of non-medical switching on clinical decision-making process; professional experience with clinical practice, patient-physician relationship, insurance process; and perceived impact on practice, staff and patients were assessed. Weighted percent responses were calculated.ResultsWe sampled 1,010 physicians (response rate = 55.5%). Many responded being frequently not amenable (26.0%) or had reservations (41.8%) to non-medical switch requests; with >50% indicating patient stability on current therapy and suboptimal alternatives as factors frequently influencing amenability. Physicians agreed non-medical switching can create ethical concerns (clinical judgement, autonomy, ability to treat per guidelines; 74.8%, 82.3%, 53.5%, respectively), while forcing them to take responsibility for insurers’ decisions (81.1%) and diverting their clinical time (84.3%). Most indicated non-medical switching increased practice burden (administrative, non-billable interactions, additional staffing, non-office patient contact, calls to/from the pharmacy; 85.0%, 72.5%, 62.2%, 64.2%, 69.5%, respectively). Physicians felt insurer processes discouraged non-medical switch challenges (76.7%) and required inconvenient lengths-of-time (76.1%) speaking to insurer representatives without proper expertise (62.0%). They believed non-medical switching negatively impacted aspects of care (effectiveness, side-effects, medication adherence and abandonment, out-of-pocket costs, medication errors; 46.5%, 53.2%, 50.6%, 49.4%, 59.6%, 54.5%, respectively).ConclusionsPhysicians were frequently not amenable or had reservations regarding non-medical switching. They noted ethical concerns due to non-medical switching. Most felt non-medical switches burdened their practice and negatively impacted care.
Highlights
Non-medical switching is typically defined as a change in a stable patient’s prescribed medication to a clinically distinct, non-generic, alternative for reasons other than lack of clinical response, side effects, or poor adherence [1,2]
Physicians agreed non-medical switching can create ethical concerns, while forcing them to take responsibility for insurers’ decisions (81.1%) and diverting their clinical time (84.3%)
In total 21,493 physicians from the Research Now-SSI (RN-SSI) panel were available for recruitment into this survey study
Summary
Non-medical switching is typically defined as a change in a stable patient’s prescribed medication to a clinically distinct, non-generic, alternative for reasons other than lack of clinical response, side effects, or poor adherence [1,2]. Due to the interplay between patients, physician practices, pharmacies and insurance companies, the process by which a patient and their physician need to respond to a non-medical switch request (either accepting or challenging it) to assure adequate and uninterrupted treatment becomes complex and time consuming (S1 Fig). This complex process misaligns with the widely accepted goal—The Quadruple Aim—of enhancing patient experience, improving population health, reducing costs and improving the work life of healthcare providers, including physicians and staff [3,4,5]. We sought to examine physicians’ openness to requests for non-medical switching and their experiences and opinions regarding the impact of non-medical switching on their practice, staff and patients
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