THE PROBLEM

Consumers are increasingly confronting a problem: The prescription drug benefits they need are not guaranteed if they switch health plans. This can mean trouble for a patient already on a prescription that works for them.

This happens because, when you switch health plans, insurers:

  • May not be obligated to cover medications you are already using;
  • Can put additional restrictions or barriers on medications you are already taking;
  • Can deny coverage of a treatment altogether.

In other words, if a consumer switches health plans, that insurer may not be required to cover the treatments that patient is already using, even when patients are successfully being treated for their condition and are medically stable on a treatment.

THE IMPACT

When a patient must switch health plans, their need for the medications they are taking doesn’t change. Their new insurance coverage, however, might through utilization review mechanisms— such as prior-authorization and denials. This can be especially harmful for those living with diabetes, heart disease, cancer, epilepsy, multiple sclerosis, HIV/AIDS, mental illness, and other serious conditions.

For these individuals and more, this is a growing reality that can result in severe health risks, trips to the emergency room and ultimately can increase health care costs.
The California Chronic Care Coalition urges policymakers across the country to take action now to prevent insurers from disrupting patient continuity of care.

Together we can protect patients – we need you to join the discussion to make your voice heard!