Impact of non-medical switching of prescription medications on health outcomes: an e-survey of high-volume medicare and medicaid physician providers

Abstract

Background: Non-medical switching refers to a change in a stable patient’s prescribed medication to a clinically distinct, non-generic, alternative for reasons other than poor clinical response, side-effects or non-adherence. Objective: To assess the perceptions of high-volume Medicare and/or Medicaid physician providers regarding the impact non-medical switching has on their patients’ medication-related outcomes and health-care utilization. Methods: We performed an e-survey of high-volume Medicare and/or Medicaid physicians (spending >50% of their time caring for Medicare and/or Medicaid patients), practicing for >2 years but <30 years post-residency and/or fellowship; working in a general, internal, family medicine or specialist setting; spending ≥40% of their time providing direct care and having received ≥1 request for a non-medical switch in the past 12 months. Physicians were queried on 15-items to assess perceptions regarding the impact non-medical switching on medication-related outcomes and health-care utilization. Results: Three-hundred and fifty physicians were included. Respondents reported they felt non-medical switching, to some degree, increased side-effects (54.0%), medication errors (56.0%) and medication abandonment (60.3%), and ~50% believed it increased patients’ out-of-pocket costs. Few physicians (≤13.4% for each) felt non-medical switching had a positive impact on effectiveness, adherence or patients’ or physicians’ confidence in the quality-of-care provided. Non-office visit and prescriber-pharmacy contact were most frequently thought to increase due to non-medical switching. One-third of physicians felt office visits were very frequently/frequently increased, and ~ 1-in-5 respondents believed laboratory testing and additional medication use very frequently/frequently increased following a non-medical switch. About 1-in-10 physicians felt non-medical switching very frequently/frequently increased the utilization of emergency department or in-hospital care. Conclusion: This study suggests high-volume Medicare and/or Medicaid physician providers perceive multiple negative influences of non-medical switching on medication-related outcomes and health-care utilization.

Switching from One Biosimilar to Another Biosimilar of the Same Reference Biologic: A Systematic Review of Studies

“…Transitions from a reference biologic to a biosimilar, or from one biosimilar to another, are often the consequence of insurance mandates and/or pharmacy benefit managers implementing formulary adjustments or limitations to reduce costs [20]. Patients might also transition between products if they relocate to a new region with different drug coverage (or if they are traveling).…”

Update on Non-Interchangeability of Botulinum Neurotoxin Products

“…This non-medical switching can disrupt the benefits of ongoing treatment, requiring clinicians to alter doses and injection sites to re-establish stable regimens for each patient, particularly because there are no fixed inter-product dose ratios. Such switching can also increase the potential for medical errors, adverse events, and cessation of treatment [ 230 ].…”

Provider and patient knowledge gaps on biosimilars: insights from surveys

“…25 In a survey of US physicians published in 2019, over 80% expressed concerns regarding nonmedical switching to biosimilars and the impact such switching would have on patient care and physician practice (Figure 2). 21,[26][27][28] In a 2019 survey of 320 US rheumatologists who prescribed tumor necrosis factor-α inhibitors, a higher proportion of respondents stated that they were more likely to initiate biosimilar treatment for a biologic treatment-naive patient with rheumatoid arthritis than they were to switch to the biosimilar for a patient with rheumatoid arthritis doing well on the reference product (73% vs 35%). 21 Likewise, in a 2020 survey of 602 specialists who regularly prescribed biologic medications to their patients, physicians were more likely to prescribe a biosimilar to patients who were newly starting therapy than to patients who were already successfully established on a reference product.…”

“…27,57 A large majority of patients (85%) in a survey published in 2019 were concerned that biosimilars would not treat their disease as well as a reference treatment would, 85% did not want to switch to a biosimilar if their current biologic was working, and 83% were concerned that switching may cause more adverse effects (Figure 2). 21,[26][27][28] Consequently, nonmedical switching is a major concern for patients. In a survey published in 2019, 79% of patients indicated that they attempt to avoid the switch; in another survey published in 2021, 43% of patients reported accepting the switch.…”