The non-medical switching of prescription medications

ABSTRACT

Non-medical switching of medication, whereby a patient’s treatment regimen is changed for reasons other than efficacy, side effects, or adherence, is often related to drug formulary changes aimed at reducing drug costs. In the era of health care reform, while cost-cutting measures are important, there is considerable evidence that non-medical switching, particularly when applied to medication used to treat chronic conditions such as diabetes, may impact patient outcomes, medication-taking behavior, and use of health care services. Ultimately, overall costs may be increased, as savings by insurers are cancelled out by higher costs to the health care system as a whole, such as extra administration, treatment failure from new medicines, and increased adverse events. The emergence of biosimilar and follow-on biologic treatments raises further questions among patients receiving biologic treatments, with patient advocacy groups calling for clear legislation to ensure that patients with complex or chronic conditions continue to receive effective, evidence-based medications for their disease. This article will discuss non-medical switching in the US, taking into account the different parties involved, such as patients, health care providers, pharmacists, payers, and pharmacy benefit managers, with the aim of providing a detailed overview of this complex and evolving topic.

KEYWORDS:

• Non-medical switching
• diabetes
• biosimilars
• follow-on biologics
• adherence

Acknowledgments

The authors received writing/editorial support in the preparation of this manuscript provided by Michael van der Veer from Excerpta Medica, funded by Sanofi US, Inc.

Declaration of interest

R Dolinar is on the speakers’ bureau of AstraZeneca, Boehringer Ingelheim, Lilly, and Novo Nordisk. F Lavernia is on an advisory board for Sanofi, Intarcia Therapeutics; speakers’ bureau for Janssen Pharmaceuticals; and has provided services for promotional purposes (not for CME/CE services) to Janssen Pharmaceuticals and Lilly. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships to disclose.

Additional information

Funding

Development of the manuscript was funded by Sanofi US, Inc.