Sometimes you may not get the medication your doctor prescribed because of therapeutic substitution. Therapeutic substitution means the medication you were prescribed has been switched by a pharmacist to a drug with different active ingredients. Therapeutic substitution is different than when a brand name drug is switched to its a generic. Generic substitution means a brand name drug is switched to a generic with the same active ingredients and is approved by the United States Food and Drug Administration (FDA) as an equivalent drug.1, 2 This is typically done to save money for an insurer.
In the case of therapeutic substitution, medicines in the same class of drugs, intended to treat the same condition, may have different active ingredients and work in different ways. This means that they can have different side effects, dosages and risks for the patient.
Because therapeutic substitution means you may not receive the medication your doctor believes is the best treatment for you, it should only be done with the full knowledge and consent of your health care provider. Despite state laws that prescribers approve therapeutic substitutions,3 both patients and prescribers may not be aware that it has occurred. This could be due to the type of notification a pharmacy or pharmacist uses.
What can you do?
1. Ask your doctor to mark your prescriptions with “medically necessary,” “may not substitute” or “dispense as written (DAW)”.
2. Ask your pharmacist to add a statement to your records saying that you do not want any medications substituted unless you and your doctor approve.
3. Call your insurance company or prescription drug plan to confirm the medication is covered by your plan
4. Before you pay for your medication, you should check to confirm it is the medication you were prescribed. It is important that you check the prescription to confirm it is correct before paying because you may not be able to return it for a refund. If you’re not sure, here are some questions you may want to ask:
- Is this the exact drug my doctor prescribed?
- Why are you switching my medication?
- Will this switch impact my health?
- Have you notified the doctor of this switch?
- Is this the same dosage as my previous prescription?
- As a patient, you should not feel pressured to agree to a proposed switch and have the right to say no.
As a patient, you should not feel pressured to agree to a proposed switch and have the right to say no.
Find out if there is proposed legislation in your state and take action.