Has your health insurance company ever urged you to switch medications? Johns Hopkins explains the risks of "drug flipping," and offers advice.
People sometimes encounter problems with their medications when they switch insurance companies. A brand of drug that is covered with a small co-pay on their former plan may not be on the formulary (the list of drugs approved by a health insurer for use by its beneficiaries) of the new one. In these cases, the company may create financial pressure to switch from one drug to another, or from a brand-name drug to a generic -- a practice sometimes referred to as "drug flipping".
If this happens to you, start by asking your doctor or pharmacist if the new drug is as safe and effective as the one you were using before. Certain classes of drugs are interchangeable at equivalent doses, meaning you may have to take a different dose of the new drug for the same effect you got from the former medication. When this happens, drug flipping can lead to confusion and can thereby increase the chance of medication errors.
It is also possible that your individual response to the “equivalent” dose of a different drug actually may not be equivalent, in which case flipping your brand might not be in your best interest. For instance, if you are getting a good result from a certain drug for high blood pressure, switching brands could be risky.
Bottom line advice. Nobody enjoys these bureaucratic problems, but they are part of the complex American healthcare system. By becoming familiar with your insurer’s formulary and drug-benefit policies, you can avoid inconvenience and unnecessary out-of-pocket expenses. Many insurers provide a condensed “pocket formulary” you can take with you when you visit your doctor. When the doctor reaches for the prescription pad, reach for your formulary and check your coverage. It may save you aggravation and expense at the pharmacy.
