Maine law holds insurers accountable, new data highlights impact of nonmedical switching

9.5.19

Last year, Maine’s legislature passed and enacted a policy that would protect patients from nonmedical switching. In addition to creating a transparent process for insurers and patients who are subjected to nonmedical switching practices, the legislation requires insurers to report any changes to their formulary, rationale for the change and its impact on patients, along with the number of exemptions requested and granted.

Under this new law, data has been collected, exposing the impact of insurers’ nonmedical switching practices.

A report, prepared by the Maine Bureau of Insurance, highlighted 329 formulary changes issued by the state’s insurers. As a result of insurers’ changes, 80 percent of the patients affected by these changes experienced an increase in their out-of-pocket costs.

“Nonmedical switching not only impacts patients financially, but it can also have negative consequences for their health,” said Scott Bruun, executive director of the Chronic Disease Coalition. “When insurers remove treatment options from their formularies, patients are forced to choose between paying more for their current medication or trying a cheaper alternative that may not be as effective.”

Patients can file for an exemption, but Maine’s data indicates that nearly half of these requests were denied. This shortsighted trend can disrupt a patient’s course of treatment and cause new side effects and symptoms to reemerge. Long-term, these practices have consequences for the patient as well as the insurance company, who will inevitably pay more for a patient with poorer health outcomes.

While Maine’s reporting requirement is new, the data highlights the frequency in which insurers issue formulary changes that have financial and physical health implications for patients. The Chronic Disease Coalition advocates for increased transparency, and we are proud that Maine’s legislation is taking a deeper look at these harmful insurance practices.