ALBANY — A little-noticed provision in state regulations allows insurance companies to switch a patient’s medication in the middle of a contract, which some New Yorkers say has forced hard choices of whether to pay the mortgage, college tuition or higher prescription costs.
A bill announced Tuesday would address this “non-medical switching.” The measure would prohibit an insurance company from forcing policy holders to switch their prescription during a contract year.
The bill passed the Assembly 144-0, yet has remained in the Senate Insurance Committee since it was introduced in March.
“Imagine spending your life battling a chronic illness and finding a treatment plan that works for you after years of trial and error, only to have the rug pulled out under you when you learn the prescriptions you have come to rely on are no longer covered,” said Sen. Sue Serino (R-Hyde Park).
But the New York Health Plan Association, which represents the interests of insurers, said that “non-medical switching” saves all policyholders by moving customers to effective medications that cost the insurers less.
“All health plan contracts have language that sets limits on the number of times that formulary changes can be made,” said Leslie Moran, senior vice president of the New York Health Plan Association. Insurance companies also provide a process that “enable patients and their providers to get exceptions to continue using specific drugs,” she said.
“It’s all spelled out in everyone’s policy,” Moran said. “However, most people don’t read their policies word for word.”
The bill would lock in covered prices while an annual contract is in place, according to the association’s letter to legislators, and would prevent “the continuous review, update and change necessary to maximize premium affordability, safety and efficiency to benefit consumers.”
Lisa Mercurio, a mother from Congers in Rockland County, said medications for her children have cost more than $100,000, because of the drugs required by her insurance company for her children’s rare maladies. She said that in recent years, the company has forced her to switch medications that were effective even though the family paid its premiums under their contract.
“It is not fair that an insurance company can hold my children’s health hostage because they are not held to the same standard,” she said