The non-medical switching of prescription medications

Postgrad Med. 2019 Jun;131(5):335-341. doi: 10.1080/00325481.2019.1618195. Epub 2019 May 29.


Non-medical switching of medication, whereby a patient's treatment regimen is changed for reasons other than efficacy, side effects, or adherence, is often related to drug formulary changes aimed at reducing drug costs. In the era of health care reform, while cost-cutting measures are important, there is considerable evidence that non-medical switching, particularly when applied to medication used to treat chronic conditions such as diabetes, may impact patient outcomes, medication-taking behavior, and use of health care services. Ultimately, overall costs may be increased, as savings by insurers are cancelled out by higher costs to the health care system as a whole, such as extra administration, treatment failure from new medicines, and increased adverse events. The emergence of biosimilar and follow-on biologic treatments raises further questions among patients receiving biologic treatments, with patient advocacy groups calling for clear legislation to ensure that patients with complex or chronic conditions continue to receive effective, evidence-based medications for their disease. This article will discuss non-medical switching in the US, taking into account the different parties involved, such as patients, health care providers, pharmacists, payers, and pharmacy benefit managers, with the aim of providing a detailed overview of this complex and evolving topic.

Keywords: Non-medical switching; adherence; biosimilars; diabetes; follow-on biologics.

MeSH terms

  • Drug Substitution / economics
  • Drug Substitution / statistics & numerical data*
  • Drug-Related Side Effects and Adverse Reactions / economics
  • Drugs, Generic / economics
  • Drugs, Generic / therapeutic use*
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Insurance, Pharmaceutical Services / statistics & numerical data
  • Medication Therapy Management / economics
  • Medication Therapy Management / organization & administration*
  • Prescription Drugs / economics
  • Prescription Drugs / therapeutic use*
  • United States


  • Drugs, Generic
  • Prescription Drugs