Non-medical switching is a strategy that health insurers use to control their costs and maximize profits by forcing stable patients to switch from their current, effective medications to drugs that may not be as effective, for reasons unrelated to health. In other words, insurers force patients to change medications for non-medical reasons, disregarding physician recommendations and patients’ individual needs.

How Does Senate Bill 924 Help Patients and Providers?

The bill protects stable patients from formulary changes for non-medical reasons by imposing certain coverage restrictions during the course of a plan year if their physician certifies the drug is medically necessary. Health insurers would be required to provide notification to both the patient and provider at least 60 days before the effective date for any change to a prescription drug formulary during a policy year.  The patients prescribing physician would then have 30 days to submit a medical necessity form which would result in continuation of coverage at the existing level.

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