Let’s hold health insurers accountable for the contracts they sign

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All business should have to honor their contracts. So why do we let health insurance companies off the hook?

If you sign a one-year lease, your landlord can’t raise the rent six months in. This makes sense. Yet, we allow health insurance companies to change their prescription drug coverage midyear, when consumers are already locked into their plans.

Commercial health insurers in Connecticut are free to make coverage changes in the middle of the year that reduce or eliminate prescription drug benefits, forcing people onto less expensive – and often less effective – medications.

The process is known as “non-medical switching,” and it can take the form of increased out-of-pocket costs, new formulary restrictions, or even total revocation of coverage for effective prescriptions that many residents rely on.

A bill currently in front of the state Senate takes steps to address this issue, but unless a new amendment is adopted, it won’t go far enough. Senate Bill 379 would require health insurers provide a 60-day notice when benefits change (currently, no notice is required), but it doesn’t prohibit insurers from making those unfair changes in the first place.

I urge the Senate to adopt the amendment, which includes a proposal originally introduced by my colleague Sen. Heather Somers and me to prohibit prescription coverage changes mid-year.

Non-medical switching is dangerous because it forces patients who are successfully managing chronic medical conditions to switch to a new medication, which may result in damaging side effects or simply not work for that particular patient. For the estimated 690,000 Connecticut residents with arthritis, 60,000 with epilepsy, and anyone else in our state who works every day to manage a chronic condition, these surprise coverage changes can put their health in jeopardy.

Non-medical switching also undermines the doctor-patient relationship. Physicians work hard to create a treatment plan that meets the needs of their patients, only to have an insurance company effectively override their professional medical opinion.

There are many factors that contribute to how someone responds to a particular drug, including age, severity of illness, gender and general health. A medication that works well for one person may not work for another—a primary reason why physicians, not health plans, should determine the course of care.

Insurance companies may claim that since these changes save money, they keep health plans more affordable for all their customers. But they fail to account for the resulting costs when patients forced off their medications react poorly. A study published by the American Psychiatric Association found that psychiatric patients who stop taking their medications because of prescription drug coverage changes are more than three times more likely to be homeless and more than twice as likely to be incarcerated. A survey by the Epilepsy Foundation founding that switching treatments can lead people with epilepsy to experience breakthrough seizures.

Non-medical switching can result in exorbitant costs for the health care system, consumers, and state government. It’s a cruel practice that benefits no one, and Connecticut legislators should put a stop to it.

Without an amended legislative solution, residents will continue to feel the health and financial effects of these practices. The bill currently being considered by the Senate still leaves those with commercial coverage vulnerable to losing access to the prescriptions they were guaranteed, disrupting the treatment that they paid for.

Health insurance companies don’t need special treatment – it’s time they honor their contracts just like any other Connecticut business. If they won’t do the right thing on their own, the legislature must hold them accountable.

Michelle Cook is the state representative for the 65th Assembly District serving Torrington and a Deputy Speaker of the House.


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