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Opinion

Protect Patients From Treatment Switches

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Over the past 26 years, I’ve treated Floridians with a wide range of complex and difficult-to-control conditions, including rheumatoid and psoriatic arthritis, lupus, and more.

These diseases can have devastating consequences. Without adequate treatment, patients can become disabled, and in the case of rheumatoid arthritis, a lack of stability can lead to a stark increase in the risk of heart attack and stroke.

To ensure my patients can stabilize their conditions and lead healthy lives, I work closely with them to find effective medications with the least amount of side effects. This process can take years.

Yet across the state, pharmacy benefit managers and commercial insurance companies are effectively forcing Floridians who are already doing well on certain medications to switch to cheaper, often less effective drugs. These insurers are either refusing to cover an ongoing treatment altogether, or they are raising the out-of-pocket cost burden in an attempt to make people switch treatments.

These coverage changes, which have no medical justification, can happen at any time, even midway through the lifecycle of a person’s health insurance policy. They are happening to a growing number of my patients.

Fortunately, state lawmakers have the opportunity to put a stop to these dangerous insurer policies. The Patient Stability Act (HB 915 / SB 1142), critical legislation now pending before the Florida legislature, would protect our most medically fragile patients.

The bill places limits on insurance coverage changes to allow people with complex, chronic and rare medical conditions to stay on the treatment regimen that has been working for them – as long as they stay on the same health plan.

The Patient Stability Act is absolutely critical to protect the health of the Floridians I treat and others with chronic or complex medical conditions. For these people, treatments are not interchangeable. Someone whose condition is controlled on one medication may not respond favorably to another, and when patients are forced to switch therapies, it can even cause the original treatment – the one that was once working – to no longer be effective.

Above all, forcing a stable patient to switch medications is dangerous and costly – both from a health and monetary perspective. The chance of complications, as well as unnecessary and costly hospitalizations, rises exponentially when insurance companies intervene in the doctor-patient relationship in this way.

Commercially insured Floridians who are battling rheumatoid arthritis and countless others across the state being treated for complex, chronic and rare medical condition should not have to live in fear that the treatments they need will be made inaccessible. State lawmakers should enact the Patient Stability Act to ensure that our most medically fragile citizens have access to the care they need.

Dr. Robert Levin, MD is a practicing rheumatologist and president-elect of the Florida Society of Rheumatology. He lives in Tampa.