February 17, 2022
Institute for Patient Access
Millions of people susceptible to blood clots started 2022 at higher risk of stroke. Why? Their health plan’s pharmacy benefit manager decided to stop covering their blood thinner.
Effective January 1, CVS Caremark abruptly dropped all but one oral anticoagulant from its commercial pharmacy benefit plan. Insurance companies use pharmacy benefit managers – often called middlemen – to administer their pharmacy benefits, and CVS Caremark is the nation’s largest. It processed 32% of all prescription claims last year.
Physicians Object to “Dangerous” Decision
More than a dozen patient and physician advocacy organizations raised issue with CVS Caremark’s change. The move was characterized as “dangerously disruptive” to patients in one letter to the company. Hundreds of physicians signed on to a similar letter that expressed outrage at the policy change.
More than 2 million Americans take blood thinners every day to help prevent – or recover from – life-threatening conditions like stroke, pulmonary embolism and thrombosis. Sudden and disruptive formulary changes can discourage adherence for patients, which can have dire consequences.
“Patients [with atrial fibrillation] who abandon anticoagulant therapy have a risk of ischemic stroke that is 2-3 times higher than those who continue therapy,” according to the advocacy organizations’ letter. For those with pulmonary embolism, the “risk of a recurrent venous thromboembolism is 10% in the first year after stopping anticoagulation,” the letter went on to explain.
The Risks of Non-Medical Switching
Forcing patients to change their medication is risky. Nearly one in 10 patients require hospitalization following a non-medical switch, according to a 2019 study led by the Alliance for Patient Access.
Among patients’ post-switch challenges captured by that research include:
- 39% of patients reported the switch so frustrating that they stopped taking their medication.
- 59% of patients suffered complications with a new medication after a switch, including in many cases, re-emergence of symptoms the previous medication had controlled.
- 40% of patients needed to go back to their health care provider more often following a switch.
Additional visits to treat patients who were otherwise stable add an undue burden to health care providers at a time when burnout is a mounting concern.
CVS Caremark is Holding Firm
Non-medical switching saves the middlemen money, but patients are plagued by side effects and inconvenience. And yet, so far, CVS Caremark refuses to grandfather in patients already stable on their existing medication – treatments that were covered just weeks ago.
It’s this audacity that has spurred greater interest in reforming laws – at both the state and federal level – to enact commonsense safeguards on non-medical switching. Doing so would be in heart patients’ best interest.
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