Friday, August 5, 2016

Could Class Substitution by Pharmacists Put Patients at Risk?

Should generic medications be substituted at the pharmacy for prescribed brand-name formulations?

Psychiatric News spoke with clinicians about “generic substitution”—the practice of substituting a generic equivalent of a brand-name drug—and the more controversial cost-control practice known as “therapeutic substitution.” The latter, which is the substitution of a different, lower cost molecule for another prescribed medication in the same “therapeutic class,” was the focus of a recent report in JAMA Internal Medicine that highlighted the potential cost-saving implications of therapeutic substitution.

“The take home from the study is that prescribing in United States is inefficient,” study author Michael Johansen, M.D., told Psychiatric News. “Too many branded drugs are used, when generics will work equally effectively at dramatically lower prices. This does not mean we shouldn’t prescribe branded drugs, but this should be restricted to times when it is absolutely necessary.”

Generic substitution is widely legal and commonly practiced. But therapeutic substitution—dispensing a different drug in the same therapeutic class—is well outside the norm. A law approved by the Arkansas state legislature in 2013 appears to be the first to legally sanction therapeutic substitution by a pharmacist.

Clinicians who spoke with Psychiatric News were unanimous that therapeutic substitution was at least unwise, and possibly dangerous.

“We know that even within relatively well-defined classes, not all drugs are the same, especially when it comes to side effects, drug interactions, and patient tolerance,” said Glenn Martin, M.D. (pictured above), immediate past speaker of the Assembly. “Psychiatrists understand and value the important role of pharmacists and are happy to collaborate with them. But class substitution without prior specific approval by the physician is not in the patient’s best interest and should definitely not be allowed to be mandated as a cost saving tactic.”

For more coverage of this issue, see the full story “Generic, Class Substitution of Meds: Does it Harm Patients?” in today’s issue of Psychiatric News PsychoPharm. For more information on APA’s reaction to the Arkansas law on therapeutic substitution, check out “Assembly Responds to Arkansas Law on ‘Therapeutic Substitution’.”

(Image: Sylvia Johnson)


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