To respond to the coronavirus, our state legislators have made millions of dollars available for relief efforts and issued sweeping mandates to support social distancing, demonstrating their will to take bold action to protect the health of Pennsylvanians.
And yet – it remains legal in Pennsylvania for health insurers to alter a patient’s coverage in the middle of the plan year, leaving those who are locked into their policies with nowhere to turn for help during one of the most challenging moments in our nation’s recent history.
This dangerous and little-known practice is called non-medical switching, and Pennsylvania lawmakers have not yet acted to address it, despite the fact that it can have serious implications for patients. I know this firsthand, because when my insurer tried to non-medically switch me, I nearly lost access to the only medication that helps me manage my rheumatoid arthritis.
That is why I am calling on the state legislature to send House Bill 853, which will end non-medical switching in Pennsylvania and protect patients’ access to their prescriptions, to Governor Wolf’s desk for his signature.
More than ten years ago, I was diagnosed with rheumatoid arthritis (RA), an inflammatory autoimmune disease that causes severe swelling and pain in my joints and also affects my eyes, heart, and lungs. Because of my condition, I had to retire early and give up hobbies I loved, including swimming, biking, and competing in triathlons. Living in constant pain took a toll on my mental and emotional health as well. I have experienced increased anxiety and depression because of what’s happening to my body.
It took years of work with my doctor to find a medicine that reduced my pain and allowed me to lead a normal life, and the prescription that my doctor chose is the only thing that limits the pain caused by my RA.
My story is not unique. For many patients with a chronic condition, finding a treatment plan that stabilizes their health can require trial and error. RA is the most common form of autoimmune arthritis, affecting more than 1.3 million Americans, including thousands of our fellow Pennsylvanians.
Last year, my insurance company non-medically switched me in a way that blocked access to my prescription. Thankfully, my physician quickly intervened, and I was able to stay on my treatment plan. But others in Pennsylvania with similar chronic health conditions may not be so fortunate.
Non-medical switching can cause serious health and financial problems. When insurers change their formulary coverage, copay costs can skyrocket without warning, forcing patients to choose between staying on their prescriptions and living within their means. Epilepsy patients who lose access to their medication because of non-medical switching can experience a recurrence of seizures which can threaten their job security and their life. Other patients may have to visit the doctor’s office more frequently, or even the ER.
For patients who depend on a medication to keep their health stable, it is frightening to receive a letter that says you have to change your treatment plan or pay more out-of-pocket for your current prescription. It’s even scarier to receive the news that your plan has changed at the pharmacy counter.
Like so many Pennsylvanians, I carefully evaluate health plans to pick the one that allows me to afford my treatments. But any insurance company I choose can change its obligation to me on a whim, while I cannot do the same. I live in fear to this day that my benefits could be pulled out from underneath me at any moment, and because of the coronavirus pandemic, I am more afraid than ever of losing coverage for my medication and of unpredictable changes to my budget. It’s upsetting and unethical.
House Bill 853 would end this insurance practice once and for all, and it’s time for lawmakers to take it up. This bill is a simple solution to ban non-medical switching that supports Pennsylvanians who rely on certain treatments to manage a chronic health condition – those who are most at risk of the effects of coronavirus.
No one should have to worry about their insurance coverage changing at any time – especially people who depend on a prescription to live a normal life, and especially during a global pandemic. If I can’t change my health plan to save money in the middle of the year, insurers shouldn’t be able to either.