On June 15th, the American Medical Association (AMA) passed a resolution opposing the practice of insurers providing financial incentives for patients to switch to a payer-preferred treatment. The resolution was drafted by the American Colloge of Rheumatology (ACR) and passed during the AMA’s June 2021 Special Meeting.
The ACR drafted the resolution after learning Cigna was notifying patients on Cosentyx (secukinumab) that they could qualify for a $500 pre-paid debit card for their medical expenses if they agreed to switch to a Cigna-preferred alternative.
“We are grateful that, through the passage of this ACR-led AMA resolution, the larger house of medicine has agreed with us that financially incentivizing patients to switch medicines is wrong. In recent years, payers have become increasingly aggressive in the tactics they have used to direct patients to the preferred treatments on their formularies,” said Chris Phillips, MD, chair of ACR’s Insurance Subcommittee.
The ACR had previously outlined their concerns with non-medical switching of patients on biologics in an April 2021 letter to Cigna:
“Due to the complex nature of autoimmune diseases, two patients can have very different immune responses to the same medication in the same drug class…This can make finding the treatment that works a challenge, so the decision to choose one biologic over another requires careful clinical evaluation and consideration by a physician and patient. Factors such as an individual patient’s age, gender, diagnosis, medications, specific organ manifestations, antibody status, disease severity, comorbid conditions, and ability to tolerate the route of administration strongly influence the choice of each specific biologic.”
“We are hopeful the AMA’s new stance will increase scrutiny of these practices and encourage policy makers to pass legislation prohibiting financial payments for non-medical switching.” said the ACR statement. The ACR says it plans to work with the AMA to oppose legislation that would explicitly allow this practice.