The misleading and potentially dangerous practice known as prescription drug “switching” is becoming more prevalent in Florida, according to a consumer alert issued today by the Consumer Federation of the Southeast and Florida PIRG. During the past few months, health insurance plans have been sending letters to their members urging them to switch from brand name medications to so-called “generic alternatives.”

The consumer advocates want patients to know a generic alternative, or “therapeutic substitution” is not the same as a “therapeutic equivalent.”

“The concept of therapeutic substitution, or ‘switching,’ can be very confusing for consumers,” said Federation director Walter Dartland. “Most people don’t understand the terminology and don’t realize the insurance companies are encouraging them to switch to a completely different drug that often has a different chemical make up and which can affect their body very differently than the medication they currently use.”

Patients are not the only ones upset by the practice of switching. Physicians are becoming increasingly frustrated with battling insurance companies that are interjecting themselves into the doctor/patient relationship.

“There are certain drug classes where it may be safe to switch from one drug to another, and there are others where switching can be dangerous - and the person deciding that should be the patient’s physician,” said Dr. Bruce Rubin, assistant professor of clinical Neurology at the University of Miami’s Miller School of Medicine. “I do not appreciate HMOs and insurance companies, who are not privy to my patient’s medical history, sending letters asking them to switch medications. It undermines the doctor-patient relationship by questioning my credibility as their physician.”

Brad Ashwell, democracy and consumer advocate for Florida PIRG, echoed Rubin’s concerns.

“Consumers are being told to switch drugs so that companies at several levels in the retail chain can make better sales – while patents may suffer serious health consequences from switching to new drugs with different side effects,” Ashwell said. “This is deeply troubling because a patient’s health should always be the top priority when it comes to any health care decision.”

The Consumer Federation of the Southeast and Florida PIRG urged patients to take these steps to protect their health interests:

• Start with your doctor. Discuss your current medication and treatment plans with your doctor. Pay close attention to the medications you’re currently prescribed and keep a written record of what drugs your doctor feels are best for your condition.
• Check with your insurance company. Since it’s possible your insurance company might practice incentivized therapeutic substitution with or without obtaining your consent, or that of your doctor, call your insurer and ask.
• Ask questions. If anyone wants to switch your medication, ask why – especially if your current prescription appears to be doing its job. Ask whether you need to take the drug with the same frequency as your current prescription.
• Appeal. If your insurance company is pushing for a new drug but your physician feels your current prescription is the safest and most effective for you, appeal the insurance company’s action. Call your insurance carrier for information on its appeal process.

Dartland emphasized switching medications for financial gain is unethical and dangerous because it puts patient safety at risk by eroding the doctor/patient relationship.

“When it comes to their health,” he said, “patients deserve all the facts.”