Non-Medical Switching Impact on Patients and Providers – Psoriatic Disease Community Taking a Stand

Non-medical switching (NMS) occurs when a payer mandates that patients switch therapies, either within or across therapeutic classes, for non-medical reasons. This type of therapeutic substitution can increase the disease burden and present safety risks for patients. Often, the insurer or pharmacy benefit manager (PBM) institutes these policies due to financial incentives, which results in differential prioritization of medications on formularies. These incentives are typically not passed on to patients; rather, they are profits for the PBM or insurer. Of note, switching to a biosimilar is outside the scope of this letter. As NMS impacts therapies for psoriasis and psoriatic arthritis, the National Psoriasis Foundation (NPF) Medical Board strongly believes that individual treatment choices are best, and solely, determined by the prescribing healthcare provider (HCP) and their patient. Psoriasis is a chronic, systemic immune-mediated disease that requires long-term treatment. Because patients have heterogeneous presentations, therapies need to be individualized to maximize benefit and minimize risks. Each therapy has distinct characteristics including onset time, shortand long-term efficacy, effects on comorbidities, and safety profiles. In decision-making, HCPs consider patients’ presentation and medical history, as well as the MOA, efficacy, and safety of the medication before prescribing. This evidence-based approach results in adherence, greater satisfaction, and reduced burden of disease. Psoriasis in patients with an individualized regimen may remain well controlled for many years. These patients may also experience improvements in mental health and other comorbidities, or possible preventative benefit. NMS can disrupt well-controlled disease. Studies have shown that, in patients with inflammatory diseases, NMS was associated with significantly worse clinical outcomes, including increased flares, poor control, and increased health care resource utilization. In patients with psoriatic disease, NMS may negatively impact patient outcomes. For example, treatment disruptions can lead to exacerbations; the new therapy may not work as well or be tolerated as the prior treatment; or the prior treatment may become less effective when attempted later.