AMA Votes Against Insurers Paying Patients to Switch Treatments

The American Medical Association (AMA) will support state and federal legislation to oppose insurance companies offering financial incentives for patients to switch from a prescribed treatment to a payer-preferred treatment following the passage of a resolution at its House of Delegates June 2021 Special Meeting. 

The American College of Rheumatology (ACR) drafted the resolution, which received unanimous support in its hearing prior to full House of Delegates approval, after learning Cigna was offering patients $500 pre-paid debit cards to switch from Cosentyx (secukinumab) to an alternative medication. Secukinumab is a biologic drug used to treat patients with psoriatic arthritis, moderate to severe plaque psoriasis, and ankylosing spondylitis. 

“We are sensitive to the need for affordable health care, and we share payers’ desires to see cost-effective treatment options for our patients…,” said Chris Phillips, MD, chair of ACR’s insurance subcommittee. “However, a one-time payment to switch from a therapy that is working well to one the patient may not respond to unnecessarily puts the patient at risk and crosses a moral and ethical line by potentially creating a conflict between what is in the patient’s financial and health interests.” 

According to the ACR, the organization reached out to Cigna this spring, explaining its ethical and professional concerns over the program. Specifically, ACR outlined the medical complexity of treating patients with rheumatic disease and the potential harmful effects of a switch orchestrated by a party other than the patient and their medical treatment team. 

“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,” said Dr Phillips. “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.”   

The insurer responded that it disagreed that the financial incentive program was coercive and that it would not be altering it, according to the ACR. 

“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,” said Dr Phillips. 

“We are hopeful the AMA’s new stance will increase scrutiny of these practices,” said Gary Bryant, MD, chair of the ACR’s delegation to the AMA House of Delegates, “and encourage policymakers to pass legislation prohibiting financial payments for non-medical switching.” 

Reference:

EurekAlert. AMA passes ACR-led resolution opposing paying patients to switch treatments [press release]. https://www.eurekalert.org/pub_releases/2021-06/acor-apa062321.php. Published online June 23, 2021.