Expert Perspectives on the Clinical Impact of Non-Medical Therapeutic Switching - Episode 4

How to Discourage Non-Medical Switching

March 26, 2021
Adam Friedman, MD, FAAD, The George Washington School of Medicine & Health Sciences

A key opinion leader emphasizes the importance of discouraging non-medical switching by communicating with patients and partnering with industry researchers.

Adam Friedman, MD, FAAD: What are ways we can help combat this? I’m just having a flashback to this past weekend, when my daughter made me do this Broadway Zoom dance class. They were doing The Lion King, and there’s a song called “Be Prepared” that 1 of the characters sings. Clearly, I paid a tremendous amount of attention to this. They keep repeating, “Be prepared, be prepared.” That is true here more than anywhere else. You need to be prepared for this. You need to have a good and easy line of communication with your patient so that when they get that notice, which you may not get, they can reach out to you immediately. There are easy ways to do this. I am not suggesting you email every patient, though certainly that is 1 way to do it if it’s HIPAA [Health Insurance Portability and Accountability Act] protected or in a compliance system. However, having a portal can be useful; many electronic medical records have a mechanism so patients can send you messages that are recorded in their chart. Another option is having an after-hours line or having, for example, staff assigned specifically to investigate prior authorizations or things related to medication coverage. That will engender a good relationship and maintain that relationship with a patient.

Next is having a good system in your practice. Many are familiar with the concept of a biologics coordinator. Well, we might need to change that title because a big part of the coordination is also really being an aggressive combatant against these new and ever-changing rules and switches that are occurring in the payer system. It is incredibly helpful to have someone who knows what they are doing, and there are a lot of ways for those individuals to get trained. I would argue that a lot of our industry partners have training programs for your biologics coordinators, and I absolutely have to mention the American Academy of Dermatology, because they have a wonderful resource, a prior authorization tool. This resource is growing by the day. If you have not checked it out, please do. I also want to mention the Alliance of Patient Access and the Derma Care Access Network, which have some really nice patient-facing resources to teach patients what is going on. If they are not understanding what’s happening, who are they going to blame? Rightfully so—knowledge is power, and if you do not know what is going on, the practitioner is the 1 who is going to be blamed, and that will strain the practitioner-patient relationship.

Another thing to think about is also what pharmacy you use. Specialty pharmacies, especially ones you trust that are not getting those kickbacks for that nonmedical switching, certainly work with patients. Very often they will try, or do everything in their power, to use coupons. They have prior authorization tools themselves, but some of the big commercial pharmacies have an incentive to switch these medicines without telling you about it. Last but not least, I recommend that practitioner is part of the solution and not the problem. The more research we have—and I would argue that we have a chance partnering with industry—the better. There could not be a better reason to do so as we both benefit from generating these data about what happens when nonmedical switching wins. Having that data per disease state is going to make our job easier when we fight the good fight to ensure this does not happen to our patients.

Transcript Edited for Clarity


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