What is ‘Non-medical Switching’ of Prescriptions?

Under current Illinois law, there’s nothing that prevents coverage changes during the course of the policy year when participants are locked into their plans. These midyear changes in coverage often cause “non-medical switching” – the practice in which stable patients are forced off their original medications, regardless of clinician recommendations and health consequences.

RHA joined with partners to support legislation that prevents insurers from changing co-pays or coverage of medicines during a plan year. The legislation, HB 4146, passed the Illinois House Insurance: Health and Life committee and awaits a hearing of the full House of Representatives.

medical drugs close up

The issue of non-medical switching was brought to our attention by our friends at University of Illinois at Chicago pharmacy.  Many patients with chronic health issues, including respiratory diseases, are being forced off their current medications or prices shift for their medication. When these changes occur, other drugs may not control their symptoms adequately.

“Medical care is not one-size-fits-all,” said Matt Maloney, Director of Health Policy at Respiratory Health Association. “Making coverage decisions based solely on cost and forcing patients to change can cause unnecessary anxiety, all while ignoring the complexities that inform a patient’s individual care plan.”

We believe that when families in Illinois carefully shop for a health plan that covers the benefits they need, they should be guaranteed the coverage they signed up for the duration of the policy year.

It is especially important that patients who rely on medications to keep their health stable can purchase insurance coverage without fear that their benefits will be changed or be eliminated during the policy year.

HB 4146 is sponsored by State Representative Laura Fine and has bipartisan support with more than 50 other co-sponsors.

Want to help RHA’s legislative efforts? Join our Advocacy Champions group to make your voice heard.

New Family Caregivers Act Recognizes Important Role of Caregivers

On January 22, 2018, the President signed into law the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act. Although RAISE is not accompanied by new funding, it is a step in the right direction in recognizing the important role family caregivers play in the care of people living with chronic illnesses, including COPD.

Couple attending a COPD conferenceIn the United States, it is estimated that more than 40 million unpaid caregivers[i] spend an estimated 30 billion hours annually caring for older family and friends, with uncompensated costs in excess of $500 billion.[ii] RAISE shines a light on these workers and calls on the U.S. Department of Health and Human Services (HHS) to work with federal agencies and an advisory council to create a national strategy to support family caregivers.

The RAISE Act has two main features:

Development of a National Family Caregiving Strategy

The Act calls on HHS to develop (within 18 months), update, and sustain a national strategy that considers myriad issues that affect family caregivers.  These include:

  • Promoting greater adoption of person- and family-centered care in all health and long-term services and support settings, with the service recipient and family caregiver at the center of care teams;
  • Assessment and services planning involving caregiver
  • Promoting greater adoption of person- and family-centered care in all health and Long-term and supportive services settings, with the person and the family caregiver (as appropriate) at the center of care teams
  • Assessment and service planning (including care transitions and coordination) involving care recipients and family caregivers
  • Information, education, training supports, referral, and care coordination
  • Respite options for caregivers
  • Financial security and workplace issues

Establishment of a Family Caregiving Advisory Council 

A Family Caregiving Advisory Council will be convened to support the development of the National Family Caregiving Strategy and advise the department on recognizing and supporting family caregivers.  Members of this Council will include family caregivers, older adults with long-term services and support needs, health care and social service providers, and other key stakeholders in the caregiving community. The Council will also include federal representatives from the Centers for Medicare & Medicaid Services, Veterans Affairs, the Administration for Community Living, and other relevant agencies.

The Family Caregiving Advisory Council’s responsibilities will include (a) an inventory and assessment of all federally-funded funded efforts to recognize and support family caregivers and the outcomes of these efforts, (b) recommendations to improve and better coordinate these federal efforts, (c) the identification of challenges faced by family caregivers, and (d) and evaluation of how family caregiving impacts Medicare, Medicaid, and other federal programs.[iii]

Respiratory Health Association is all too familiar with the essential role that family caregivers play in the lives of their loved ones living with chronic lung disease.  We are encouraged by the passage of the RAISE Act and the promise it may hold for the millions of families affected by respiratory diseases and other conditions.   We will monitor the implementation of the new law and contribute the experiences of our supporters to assure  that the mandates of this new law will be fulfilled.


[i] https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf

[ii] https://states.aarp.org/family-caregivers-provide-522-billion-in-uncompensated-care-per-year/

[iii] H.R. 3759. https://www.congress.gov/bill/115th-congress/house-bill/3759