Amid Cigna controversy, AMA adopts policy on financial incentives for switching treatment

The AMA has adopted a new policy that discourages health insurance companies from offering financial incentives to patients for switching medications, according to the organization.

In March, the AMA said that Cigna offered eligible patients a $500 prepaid medical debit card if they stopped taking Cosentyx (secukinumab, Novartis) and switched to a payer-preferred alternative. In response, Chris Phillips, MD, chair of the American College of Rheumatology Insurance Subcommittee, sent a letter to Cigna’s Chief Medical Officer Scott Josephs, MD, urging the company to immediately revoke the policy.

“The decision to choose one biologic agent over another requires careful clinical evaluation and consideration by a physician and patient,” Phillips wrote in the letter. “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. The complex medical decision-making, and subsequent risks associated with these medications, fall on the physician and the patient, so these decisions should not be curtailed by a health plan’s coverage policies.”

Phillips applauded the AMA’s new policy.

“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,” he told Healio Primary Care. “In recent years, payers have become increasingly aggressive in the tactics they have used to direct patients to their ‘preferred’ treatments, in tandem with the increasing influence of pharmacy benefit managers and the rebates they extract from manufacturers to obtain preferred formula placement. This has led to increasingly non-evidence based and onerous specialty drug tiering protocols.”

Phillips added that direct payments to patients for switching “from a non-preferred to a preferred treatment crosses a moral and ethical line by potentially creating a conflict between what is in the patient’s financial and health interests.”

In a press release, the AMA encouraged state and federal officials to prohibit or discourage policies that create “needless risk for patients who are stable and on an effective therapy.”

“The patient-physician relationship is the cornerstone of health care, and decisions about which drug is best for a patient should not be made based on financial incentives offered by insurance companies,” AMA Board Member Ilse R. Levin, DO, MPH, said in the release. “Particularly at a time of economic uncertainty and during a public health emergency, payers should not be advancing strategies that prey upon financial instability and jeopardize patient health.”

In a statement to Healio Primary Care, a Cigna representative said, “there is nothing ‘needless’ ... about making sure a customer’s financial wellbeing is being addressed with the same importance and urgency as their clinical wellbeing.”

“We are committed to driving medication safety and affordability for customers and clients,” the statement said. “Over the past several years, brand-name treatments for inflammatory conditions have been among the highest drivers of drug spending, and this program is intended to encourage conversations between the prescribing physician and the patient about appropriate treatment options, new drug therapies available, out-of-pocket costs, and the patient’s health and safety.”

The Cigna representative noted that eligible patients can receive the $500 incentive after filling two prescriptions for a preferred alternative treatment during specified dates; the patient can receive the incentive even if they switch back or switch to a different treatment.

References:

American College of Rheumatology. Letter to Cigna. Available at: https://www.rheumatology.org/Portals/0/Files/ACR-Cigna-Letter-Incentivizing-Patients-Switch-Treatments.pdf. Accessed June 16, 2021.

AMA. AMA announced policies adopted on first day of Special Meeting. Available at: https://www.ama-assn.org/press-center/press-releases/ama-announced-policies-adopted-first-day-special-meeting. Accessed June 16, 2021.