By Shaina Smith – U.S. Pain Foundation.
Among the 3,436 bills that have been filed so far in the state of Washington, there’s one in particular residents with chronic conditions will want to champion for this legislative session: House Bill 2310/Senate Bill 6147. Time will be of the essence, however, as Washington has an extremely short session—two months to be precise.
Why is this measure important for Washingtonians? For one, it provides prescription stability for families who rely on continuous therapies to manage chronic diseases such as arthritis, cancer, Crohn’s disease, chronic pain and epilepsy, to name a few. Many residents may not be aware, but insurers can make prescription coverage changes to its formulary after an individual or family has enrolled in a health plan. It’s disgraceful and shocking, but unfortunately true. Here’s how it works: Families and individuals often spend months researching the best health plan that will cover their medical needs. They select the plan during open enrollment and enter into a contract with that insurance plan. The enrollee holds up their end of the agreement—making monthly payments and staying in-network for the plan’s preferred list of doctors. The insurer, on the other hand, has the liberty to make midyear formulary changes, increase out-of-pocket costs and even move medications to a more restrictive tier. This insurer cost-saving measure forces adults and children alike off their medically necessary treatment option. The patient is then powerlessly driven to an alternative medication. This harmful practice, known as non-medical switching, is the loophole that currently exists in Washington.
Luckily for residents of the state, legislators have recognized the need to better protect the families they serve by introducing HB 2310/SB 6147. Advocacy action on the legislation, Concerning prescription drug insurance continuity of care, is off to an impressive start. Just recently, the Senate version was heard before the Health and Long Term Care Committee, where support outnumbered the opposition, 40 to 8. But it’s too early to get excited due to the predictable sentiments that are once again being shared by insurers, who claim that the appeals process is sufficient for ensuring continuity of care. Fortunately, Senator Rivers stood up to those arguments by saying the appeals process is not enough—I agree.
What’s more concerning than the opposition’s claim is that House Committee members are considering amending HB 2310 to limit it to the individual market, which, according to intel on-the-ground, is only about 4% of the population. All residents, not just the 4%, deserve protections to remain stable on their pharmacologic therapies. Such safeties can also benefit the economic and societal impact caused by non-medical switching.
If committee members are seeking to drive healthcare costs down, they should seriously consider voting in favor of these measures without amendments. Healthcare costs actually go up due to unprotected families taking extra trips to their doctor or the ER, undergoing lab tests or seeking outpatient care when their bodies negatively react to the change in their treatment plan. Those individuals with epilepsy, for example, who recently switched medications sought more in-patient and emergency care than those who did not. Patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or Crohn’s disease who switch treatment due to a formulary change incur 37 percent higher all-cause medical costs (which include hospitalizations, ER visits, and outpatient visits) and 26 percent higher total costs than patients who are not switched.
Medical continuity of care is not just a notion. It’s an individual’s livelihood and a right. House Bill 2310 and Senate Bill 6147 holds insurers and pharmacy benefit managers accountable so that once a family enters into a health plan contract, they’re not left guessing if their prescriptions will be covered or not. It’s time to protect families, including children and adults living with chronic conditions, from having appropriate treatment options financially inaccessible. All families deserve continuity of care, so let’s see to it that your Washington state Representatives and Senators vote in favor of these measures.
Shaina Smith is Director of State Advocacy & Alliance Development for the U.S. Pain Foundation
 Zachry III WM, Doan QD, Clewell JD, Smith BJ. Case-control analysis of ambulance, emergency room, or inpatient hospital events for epilepsy and antiepileptic drug formulation changes. Epilepsia. 2009:50(3);493-500.
 Chao, J., Lin, J., Liu, Y., & Skup, M. (2015). Impact of non-medical switching on Healthcare costs: a claims database analysis. Value in Health, Volume 18 (Issue 3), pp. A252.