When insurers or pharmacy benefit managers (PBMs) switch patients from one clinically similar but chemically distinct medication to another for reasons apart from lack of effectiveness, tolerability or adherence, the change is called non-medical switching (NMS). These switches are often driven by formulary or coverage changes rather than by patient need, and they can have unintended consequences for health, adherence and costs.
Researchers from Johnson & Johnson, the University of Connecticut, the Medical University of South Carolina and the Idaho State University College of Pharmacy conducted an updated systematic review to evaluate the impact of NMS on ambulatory patients. Expanding on a prior review published in 2016, the study analyzed 38 U.S. real-world studies, including 11 newer analyses, covering 260,000 patients across cardiometabolic, immune-mediated, psychiatric and other conditions.
The review found that non-medical switching was most often associated with neutral or negative outcomes across clinical, economic and behavioral measures, while only about 10% of endpoints were associated with a positive effect. Studies restricted to patients who were stable before the switch were only associated with neutral or negative outcomes, including worsened disease control, increased costs and poorer adherence outcomes. Non-medical switching may achieve short-term acquisition cost savings but often undermines long-term clinical stability and increases downstream utilization.
This research was funded by Johnson & Johnson and conducted in collaboration with researchers from the University of Connecticut School of Pharmacy, the Medical University of South Carolina and the Idaho State University College of Pharmacy. For full details on the study design, methods and limitations, see: Weeda E., et al. The impact of non-medical switching among ambulatory patients: an updated systematic literature review. Published online October 4, 2019. Journal of Market Access & Health Policy, 7(1), 1678563 doi.org/10.1080/20016689.2019.1678563.
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