ATLANTA - The American Medical Association (AMA) House of Delegates passed a resolution developed by the American College of Rheumatology (ACR) to oppose insurance companies providing financial incentives for patients to switch from their prescribed treatment to a payer-preferred treatment during its recent June 2021 Special Meeting. The ACR drafted the resolution after learning Cigna was notifying patients on Cosentyx (secukinumab) that they could qualify for a $500 pre-paid debit card for their medical expenses if they agreed to switch to a Cigna-preferred alternative.
"We are grateful that, through the passage of this ACR-led AMA resolution, the larger house of medicine has agreed with us that financially incentivizing patients to switch medicines is wrong. In recent years, payers have become increasingly aggressive in the tactics they have used to direct patients to the preferred treatments on their formularies," said Chris Phillips, MD, chair of ACR's Insurance Subcommittee.
Secukinumab is a biologic medication used to treat psoriatic arthritis, moderate to severe plaque psoriasis, and ankylosing spondylitis. Ten other specialty societies signed on as cosponsors of the ACR's resolution, and it received unanimous support in its hearing prior to approval by the full House of Delegates. As a result, the AMA will now be supporting state and federal legislation to oppose the practice and will engage with state and federal regulators.
Gary Bryant, MD, chair of the ACR's delegation to the AMA House of Delegates was encouraged by the broad support across specialties and state medical associations.
"We are hopeful the AMA's new stance will increase scrutiny of these practices and encourage policy makers to pass legislation prohibiting financial payments for non-medical switching."
The ACR sent a letter to Cigna in April expressing concerns that the program used money to unethically encourage patients who were stable on an effective therapy to make decisions against the best interest of their health, especially those affected by the pandemic or in a lower socioeconomic status. The letter outlined the medical complexity of treating rheumatic diseases and potential affects non-medical switching could have on patients.
"Due to the complex nature of autoimmune diseases, two patients can have very different immune responses to the same medication in the same drug class," explained Dr. Phillips. "This can make finding the treatment that works a challenge, so the decision to choose one biologic over another requires careful clinical evaluation and consideration by a physician and patient. Factors such as an individual patient's age, gender, diagnosis, medications, specific organ manifestations, antibody status, disease severity, comorbid conditions, and ability to tolerate the route of administration strongly influence the choice of each specific biologic."
Cigna responded that they would not be making changes to the program and did not feel the payments are coercive. The ACR plans to work with the AMA to oppose legislation that would explicitly allow this practice, as well as its ongoing efforts to support lowering the overall cost of drugs while preserving patient access. More information about the ACR's 2021 policy priorities is available on the ACR website.
"We are sensitive to the need for affordable healthcare, and we share payers' desires to see cost effective treatment options for our patients. When patients cannot afford their medications, it can lead to treatment abandonment that can result in flares and irreversible damage," said Dr. Phillips. "However, a one-time payment to switch from a therapy that is working well to one the patient may not respond to unnecessarily puts the patient at risk and crosses a moral and ethical line by potentially creating a conflict between what is in the patient's financial and health interests."
About the American College of Rheumatology
The American College of Rheumatology is the nation's leading medical association for the rheumatology community and represents more than 7,700 U.S. rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization, the ACR is committed to improving healthcare for Americans living with rheumatic diseases and advocates for policies and reforms that will ensure safe, effective, affordable, and accessible rheumatology care.