The reality is that, in many situations, NMS not only leads to poorer outcomes for patients, but also higher overall costs to the payer. NMS is an established cost-saving practice where insurers or pharmacy benefit managers (PBMs) switch a patient’s medication from one on which they are established and stable to another that is cheaper. The policy is largely implemented in chronic diseases with large patient populations, such as diabetes, asthma, rheumatoid arthritis, psoriasis, psoriasis arthritis and Crohn’s disease. NMS can be implemented by insurers excluding drugs from their formularies or placing specific drugs in a specialty tier, with drugs in this tier having prohibitive out-of-pocket costs to the patient, thus making them unaffordable.¹ The increased financial burden on a patient to continue their medication often forces them to switch to the cheaper option preferred by the plan. Regardless of the approach, switching can cause significant distress for patients, as shown by a poll from the Alliance for Patient Access (n=800) to gain insight into the true impact of NMS on patients. Sixty percent of patients reported initial difficulty in finding a medicine that worked for them, with a further 88% reporting that they relied on their medicine to go about their daily lives. When asked why they had switched, patients reported various reasons: health plans had excluded their drugs from the formulary (41%), their medicines had been moved into a specialty tier (33%) or their plans had decided to withdraw validity of co-pay coupons (10%). What’s more, communication to the patient regarding the decision to switch is often “buried” in paper documents, with 48% of patients only apparently learning of the change at the pharmacy when attempting to purchase their medicine.²