Switching Biologics

Switching Biologics

By Brianna Pepin

Clinical, Logistical, and Emotional Considerations 

If you’ve been in the world of biologics long enough, you know that switching therapies isn’t always easy—for patients or for us. Whether it’s an insurance-mandated switch, a reaction, or a medication just not working anymore, these transitions are rarely straightforward. And for patients, they can be downright overwhelming. So how do we make these transitions as smooth as possible? What should we be documenting? And when do we need to raise our hand and escalate? Let’s break it down.  

Supporting Patients Through a Smooth Transition Start with the why. 
As soon as we know a switch is happening, we need to explain the why to the patient. Maybe their insurance changed, maybe their body’s stopped responding, or maybe there’s something better available. Whatever the reason, the patient needs to understand it—and feel like they’re not being left in the dark. 

Set clear expectations. 
Walk them through the process: how long approvals might take, whether they'll need loading doses, and what (if anything) they might feel as their body adjusts. The unknown is often what scares people the most—clear expectations make a world of difference. 

Validate their emotions. 
Some patients will be fine. Others will be frustrated, anxious, even mad. Especially if what they were on was working. It’s okay to say, “I get it, this is frustrating.” Just showing that you see them can help lower the emotional temperature. 

Avoid gaps. 
Treatment gaps can mean flares, and flares can mean stress, pain, missed work, and more. As much as possible, time the transition so there’s overlap or at least a quick handoff. Sometimes that means getting bridge samples or coordinating an urgent appeal—we do what we have to do. 

Give them something they can hold on to. 
A quick one-pager outlining the new medication, what to expect, and who to call if something goes wrong? That goes a long way. A verbal rundown is great—but pairing it with something written really helps patients feel confident and informed. 

 What We Should Be Documenting Documentation isn't just about keeping records—it’s about protecting the patient and the clinic. Here’s what I always make sure to include:

Reason for the switch – medical vs. non-medical (like insurance changes) Treatment history – dates, doses, responses, failures, side effects  All communication – calls with the patient, pharmacy, or prescriber. New prescription details – start dates, loading doses, pharmacy, ship date  Patient feedback – symptoms, flares, side effects, emotional state  Support offered – bridge meds, education, appeals, etc. Templates or checklists can help make sure nothing’s missed—and make training new team members a lot easier, too. 

When to Escalate 

We all know that not every situation calls for escalation. But here are a few times when I absolutely make some noise: 

The patient’s going to run out before the new med arrives

 They’re flaring and can’t wait weeks for approvals 

The insurance denied everything—even after an appeal 

We’re worried about their safety—allergic reactions, infection risk, comorbidities 

The emotional toll is affecting their willingness to stay on treatment Escalation might mean looping in the provider for a letter of medical necessity, getting a rep from the manufacturer involved, or even pulling in leadership if we keep hitting system-wide roadblocks.  

Bonus Tips for a Patient-Centered Switch Loop in the whole team. 
Nurses, MAs, and front desk might all touch this process—keep them informed so they can support the patient, too.

 Check in after the start. 
A quick “Hey, did you get your med? How are you feeling?” call builds trust and catches issues early.

 Empower your patient. 
If they know how to recognize side effects, track symptoms, or push back with insurance—they’re going to feel way more in control. And that makes everything easier.  Switching biologics doesn’t have to feel like the rug’s been pulled out from under the patient. With the right support, clear documentation, and a little empathy, we can help them feel confident in the transition—and keep their treatment on track. It’s not always easy. But it is worth it.  

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