What To Do If An Insurance Carrier Insists You Switch Drugs (Therapeutic Substitutions)
In recent years, many Pharmacy Benefit Managers have switched a patients' drugs to a drug other than the one which was prescribed. Many patients were only notified of the switch when they received a refill at their pharmacies or through the mail.
Switching drugs from the ones prescribed by your doctor takes away your right to consent. While the effects of the new drug are meant to be the same as the old, different drugs have different effects in different people.
Keep in mind that you do not have to accept the switch. You can question any changes.
To question a drug change, consider the following:
- Start by contacting your doctor or his/her office and make them aware of the switch. What does your doctor feel about the drug to which the insurer is trying to switch you?
- If you cannot get through to your doctor or his/her assistant, ask your pharmacist about the switch. Keep in mind Questions To Ask When You Are Prescribed A New Drug.
- You can also ask the insurer about the switch. Consider such questions as:
- Why is a change indicated?
- What is the difference between the prescribed drug and the proposed drug?
- Are the insurer's prescription benefits administered by a company that is owned or allied with the maker of the new drug?
- What is the price of the new drug compared to the price of the drug I was using?
If you disagree with the switch: Call the insurance company to find out who to contact about a change in your drugs and your objection to the change. Ask to speak with a person who has authority to make an exception about a prescription drug that has been switched.
If you are not allowed to speak with the appropriate person, ask for his or her name and email or snail mail address and write a letter (by fax or certified mail, return receipt requsted.)
Include in the conversation and in your letter:
- What switch occurred (from what drug to what drug).
- Explain the objection.
- State that you refuse the change.
- Insist on your original medicine.
- Ask for an expedited review of the situation so you will get your answer as quickly as the insurer's procedures allow.
NOTE: If you get approval for the change on the telphone: Get the person's name, position and contact information. Ask him or her to write you a letter confirming that you do not have to switch. Ask how long it will take to receive the letter. If you do not receive it within the specified time, call or write the person immediately, let him/her know it has not been received, and ask for it again.
If you suffer due to a drug switch, report it. Contact the FDA's MedWatch program. The program monitors patients' adverse reactions to drugs. Call: 800.332.1088.