Physicians’ perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey

Autoři: Tabassum Salam aff001;  Amy Duhig aff002;  Aarti A. Patel aff003;  Ann Cameron aff002;  Jennifer Voelker aff003;  Brahim Bookhart aff003;  Craig I. Coleman aff004
Působiště autorů: Medical Education, American College of Physicians, Philadelphia, PA, United States of America aff001;  Consulting Services, Xcenda, Palm Harbor, FL, United States of America aff002;  Janssen Scientific Affairs, LLC, Titusville, NJ, PA, United States of America aff003;  University of Connecticut School of Pharmacy, Storrs, CT, United States of America aff004;  Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, United States of America aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Physicians are in an ideal position to describe the impact of medication non-medical switching (switching commonly due to formulary changes by insurer for reasons unrelated to patient health) on their practice dynamics and patient care. We sought to examine physicians’ openness to requests for non-medical switching and their experiences and opinions regarding the impact of non-medical switching on their practice, staff and patients.


An online survey of randomly-sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. The impact of non-medical switching on clinical decision-making process; professional experience with clinical practice, patient-physician relationship, insurance process; and perceived impact on practice, staff and patients were assessed. Weighted percent responses were calculated.


We sampled 1,010 physicians (response rate = 55.5%). Many responded being frequently not amenable (26.0%) or had reservations (41.8%) to non-medical switch requests; with >50% indicating patient stability on current therapy and suboptimal alternatives as factors frequently influencing amenability. Physicians agreed non-medical switching can create ethical concerns (clinical judgement, autonomy, ability to treat per guidelines; 74.8%, 82.3%, 53.5%, respectively), while forcing them to take responsibility for insurers’ decisions (81.1%) and diverting their clinical time (84.3%). Most indicated non-medical switching increased practice burden (administrative, non-billable interactions, additional staffing, non-office patient contact, calls to/from the pharmacy; 85.0%, 72.5%, 62.2%, 64.2%, 69.5%, respectively). Physicians felt insurer processes discouraged non-medical switch challenges (76.7%) and required inconvenient lengths-of-time (76.1%) speaking to insurer representatives without proper expertise (62.0%). They believed non-medical switching negatively impacted aspects of care (effectiveness, side-effects, medication adherence and abandonment, out-of-pocket costs, medication errors; 46.5%, 53.2%, 50.6%, 49.4%, 59.6%, 54.5%, respectively).


Physicians were frequently not amenable or had reservations regarding non-medical switching. They noted ethical concerns due to non-medical switching. Most felt non-medical switches burdened their practice and negatively impacted care.

Klíčová slova:

Decision making – Drug therapy – Insurance – Medical ethics – Physicians – Primary care – Surveys – Treatment guidelines


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2020 Číslo 1
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