HEALTHPhysicians say no to automatic therapeutic drug substitutionsProponents say drug swaps can work as long as doctors are kept in the loop.By Victoria Stagg Elliott, amednews staff. Jan. 1/8, 2001. Orlando, Fla. -- The AMA reinforced its stand against automatic therapeutic substitution by pharmacists without physician authorization and pledged to work at the state level to maintain and establish laws protecting patients from generic substitution of critical-dose drugs. Doctors pushed for such action at the AMA's Interim Meeting last month, saying substitution without physician knowledge puts patients at increased risk of side effects and interactions with other medications. The AMA has long-standing policies against automatic generic and therapeutic substitution except when allowed by a health care institution's pharmacy and therapeutics committee and approved by the medical staff. According to policy, the physician also must have the right of refusal. State laws and pharmacy regulations generally prohibit automatic substitution, although pharmacists typically are allowed to substitute available A-rated generics, unless the doctor specifies otherwise or the drug has a narrow therapeutic index. Nonetheless, doctors at the Interim Meeting painted a grim picture of the challenges patients face in obtaining the exact medicines ordered. For example, some spoke of patients with chronic conditions whose brand-name drugs are regularly changed without physician knowledge because pharmacies allegedly receive drug company incentives to favor one brand over another. If a generic is substituted, the patient may get a different one every time a prescription is filled because drug price fluctuations affect pharmacy supplies.
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Copyright 2001 American Medical Association. All rights reserved.
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