[e-drug] Generic substitution (cont'd)

[James Russo <jbrusso@aol.com>]

E-drug: Generic substitution (cont'd)
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In the US, laws forbidding generic substitution by retail pharmacists
were on the books in every state until the mid-1970s. In that decade,
states began permitting pharmacists to substitute, in response to
efforts of pharmacists and consumer activists seeking reduced drug
costs. Today, substitution is legal and common throughout the US.
However, ever state requires a prescriber's order for a branded
product to be honored if "do not substitute" or directions to that effect
are on the prescription. Drugs with a narrow therapeutic index are
rather often prescribed that way. Typically, the laws permit the patient
to insist on the branded product even if the prescription does not so
specify. Interestingly, many American patients are even more "brand
loyal" than their doctors. In such cases, insurers usually require a
higher co-pay for the brand. 

I believe it is fair to say that this system works fairly well, by and
large. However, it needs to be borne in mind that the US has a
relatively well developed federal regulatory system, our domestic drug
firms, brand and generic, are inspected regularly, and instances of
drug failure are cause for immediate recall and regulatory action.
Sound policy, it seems clear, requires such a system-wide approach,
as opposed to a blanket assumption either that all formulations of all
medicines are interchangeable, or that none are. 

James B. Russo
Executive Director
The Partnership for Quality Medical Donations 
146 Koenig Road
Bernville, PA 19506
USA
tel: +1 610 488 8303
fax: +1 610 488 7036
e-mail: jbrusso@pqmd.org

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