Today, 3/30/23, the Des Moines Register published an opinion essay by Lynn Rankin. She advocated for a proposed law to restrict insurance companies from requiring patients taking high-cost drugs to try switching to lower-cost drugs that are considered therapeutically equivalent.
It is very reasonable for both private and government-sponsored healthcare plans to require you to try a lower-cost drug that meets your needs before going to a higher-cost drug. If you start on a high-cost medication, it seems reasonable to ask you to try a lower-cost drug that has been determined to be therapeutically equivalent. If you and your doctor don’t want to try a lower-cost drug first, it again is very reasonable to require a prior authorization request that shows evidence why the lower-cost drug should not be tried first. It is also reasonable to charge higher co-pays for higher-cost drugs as an incentive to encourage the use lower cost alternatives.
It is very easy for doctors to prescribe the newest and most costly drug to treat any illness, especially since patients typically pay out of pocket only very a very small portion of the total cost of the drugs they take. That is part of the reason why our health insurance costs are so high. If people had to pay the full amount for the drugs they take, they would look for lower cost alternatives on their own.