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    Op-Ed
    Friday, April 26, 2024

    Protecting patient rights to best medicines

    Imagine you are struggling with cancer or multiple sclerosis and you and your doctor finally find a treatment and prescription that successfully combats your illness. Not only do your symptoms diminish, but your entire life seems to be moving in a positive direction and you have hope.

    Then, suddenly, your health insurance carrier switches out that life changing prescription that has dramatically improved your life, to a lower cost alternative. Or perhaps the insurer decides to stop covering the drug at all. You are now forced onto a lower cost and, in many instances, less effective drug. Your symptoms return with a debilitating impact and your illness is no longer being held at bay. Not only your health, but everything in your life suffers including work, family and friends.

    For many this story has been a reality, whether the prescription is aimed to successfully treat a cancer diagnosis, multiple sclerosis or diabetes. Without notice, many are experiencing their health insurer implement a mid-term formulary change.

    This legislative session I have co-sponsored legislation that would begin to address this issue. Senate Bill 379 would ensure that patients and providers receive sufficient advance notice of drug coverage changes and the patient is allowed to remain on the effective drug with the same terms and conditions through the term of the health insurance policy, if the doctor determines that the drug is the best treatment option for a patient. This is not only a great public health concern, but also a matter of contractual fairness that prohibits insurance companies from changing the rules in the middle of the term.

    Insurers will still be able to add new lower cost generic drugs to their formulary and patients could be switched to those drugs, but only if their doctors agree that the drug is therapeutically equivalent. Research shows that forced medication switching by insurers actually results in higher costs due to reduced efficacy, complications, increased doctor’s visits and harmful side effects. This bill will protect patients and it will save insurers money in the long run.

    Patients should not have to choose between paying out of pocket for the drug recommended by their physician when it was originally covered under contract, risking their health on new medication while paying for insurance.

    Many other states, including Louisiana, New Mexico and Texas, have already adopted legislation prohibiting or restricting the ability of an insurer to change a drug or alter the terms of a patient’s coverage during a policy term. Connecticut should follow suit and listen to what our physicians are prescribing as best practices.

    Passing this legislation will take an important step to improving health outcomes for patients and offer Connecticut residents a better quality of life with the medication they need; the medication that is recommended by the person who understands their health needs the most intimately – the physician.

    Heather Somers is a Connecticut state senator. She lives in Groton.

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