Opinion: This law would stop insurers from putting profit over patients
I will never forget the day that my life was turned upside down by a medical diagnosis that was bleak. One moment I was healthy, and the next moment I was fighting for my life. While I am grateful for health care professionals and lifesaving drugs that helped me overcome such a difficult experience, I struggled to navigate our complicated health care system. That experience instilled in me a desire to advocate for patients’ rights and the importance of making sure all patients get access to essential treatments.
It cannot be overstated how hard it is for people suffering from a chronic condition to find a doctor in-network, get a diagnosis and find an effective treatment plan. For some people, the process takes months of trying one drug after another, hoping for a miracle. For others, it can take years of waiting for a new approved drug that may be able to alleviate symptoms and allow them to live a “normal” life.
So, I was alarmed to learn that thousands of Utahns were just subjected by their insurers to a practice known as “non-medical switching.” Our legislature should look at the more than dozen states that have passed laws protecting patients by not allowing insurers to put profits over patients.
Non-medical switching is a term used to describe the practice of changing a patient’s medical treatment for reasons other than efficacy. Multiple studies have shown that it leads to adverse health outcomes for patients because the new treatment might not be as effective or could induce new side effects. And, that assumes that there is another effective drug available to be prescribed. That’s not the case for patients who used to take Dupixent.
We often celebrate medications that bring about small incremental improvements for people with chronic diseases. But Dupixent is anything but small and incremental — it was a true breakthrough. Approved by the U.S. Food and Drug Administration for the treatment of severe asthma and atopic dermatitis, it has transformed the lives of countless Utah residents who suffer from these debilitating conditions.
There is no generic in this situation — this is a decision that simply boils down to cost. And, while cost-efficiency is undoubtedly an important consideration, it should never come at the expense of patient well-being. This stance runs counter to the principles that underpin the medical profession: To prioritize the best interests of the patient and to ensure they receive the most appropriate care.
What’s particularly concerning is that if this can be done for this drug, what will be the next drug on the chopping block? This decision sets a dangerous precedent that other insurance providers might follow, potentially denying access to other essential medications for patients in need.
Moreover, it’s worth noting that we are talking about a treatment that the FDA has approved for specific treatment. Rigorous clinical trials and extensive research support its safety and efficacy. In this context, making the decision to limit access seems arbitrary and, quite frankly, unjustifiable.
Decisions about medical treatments should be made by health care professionals in consultation with their patients, considering the most current medical evidence and the unique needs of each individual. What’s even more concerning is that patients who signed up for insurance plans, with an approved drug list, are effectively having that list changed in the middle of the year. This not only creates confusion but also undermines the trust patients place in their insurance providers.
It is hard to stand by while patients in Utah are denied access to medication that could significantly improve their lives. The denial of this treatment is a stark reminder that there is still much work to be done in reforming our health care system to prioritize patient well-being over profit margins.
It is imperative that Utah lawmakers and regulators look at laws like those passed in Texas, Indiana, Florida and Nevada that ensure that insurance providers cannot arbitrarily restrict access to medications. Every patient in Utah deserves the chance to receive the best available medical care, especially when it has the potential to be life-changing. We must stand together to protect patient rights and ensure that access to essential treatments remains a fundamental pillar of our health care system. Anything less is a disservice to the people our health care system is meant to serve.
Chelsea Robarge Fife is a public relations professional who is passionate about reforming our health care system, and ensuring that it serves the most vulnerable in our society.
