It came to my attention that sometimes when we go to the doctor and he or she gives us our prescriptions, and we go to the pharmacy to get it filled, we arenâ€™t always given what our doctor prescribed. I can hear some of you now, â€œWhat do you mean, Iâ€™m not given the medication my doctor asked forâ€. Â Thatâ€™s right! Â Youâ€™re not always given the prescription written down. Â As I said itâ€™s not illegal, but it ainâ€™t right, and no, Iâ€™m not talking about a generic drug versus brand name drugs. Â In the medical world they call it â€œTherapeutic Substitutionâ€, but in the real world itâ€™s called plain ole drug switching.
Hereâ€™s how it works, you go to your doctor and he or she writes you a prescription for your ailment. You take the prescription to your local pharmacy to get it filled. Now check this out, not all the time, but on some occasions the pharmacist may or may not give you the prescribed medication. Ohâ€¦. you get a medication that will treat your ailment, they call that giving you a drug in the same class, and itâ€™s just not the same thing your doctor asked for. Â No, itâ€™s not a generic drug, that wouldnâ€™t be that big of an issue, the issue is the switch is a totally different drug, without the doctorâ€™s permission and in most cases, without our knowledge. Â Generic switching is when a generic drug is prescribed over a brand name drug and is dispensed by your pharmacist. Although a generic may differ in inactive ingredients and some other aspects, such as rates of release, a generic contains the same active ingredient(s) in the same dosage as the brand name medication. And the fact is that generics are defined as being the same as the brand name drug.
Drug Switching (Therapeutic Substitution) is the practice of giving a different drug, that they (some pharmacists) say is not chemically or generically different from the prescription written by your doctor. Â Well, if itâ€™s all the same, just give me what was written. The major issue for me is that all three of us; me as the patients, my doctor and the pharmacist should all have a say in the decision of switching anyoneâ€™s medication. There are a number of physician groups opposed to drug switching and at the least, doctors have expressed fears.
As always, youâ€™ve got to â€œfollowâ€ the money. Who would be in support of drug switching? Â Iâ€™m glad you asked. Â A number of pharmacy groups are in support of drug switching as a way to control costs. Â The fact that there is very little to no conversation between the doctor and the pharmacists before the switch is made, leads me to believe that drug switching (therapeutic substitution) is of concern. Â I have a great deal of respect for pharmacists, but I also know they are not medical doctors. Â They are not aware of the conversations had between you and your doctor, which may lead to him or her prescribing an inadequate type of medication.
As I said, letâ€™s follow the money. Â Health Maintenance Organizations (HMO) are growing in record numbers as a cost-effective way of providing health care. Â In some health policies, drug switching (therapeutic substitution) is authorized and practiced. Under this concept a drug that has been determined to be just as good as what your doctor prescribed to a second drug, even though it is not chemically equivalent to the prescribed drug, is automatically given to you without contacting your doctor.
How often does this happen and to whom? Â A study was held to learn the extent and conditions under which therapeutic substitution was being practiced in an HMO setting. The main goal of the study was to learn how many programs authorize drug switching (therapeutic substitution) and what drugs are allowed, and what measures are followed once the switch is made. Of the 481 surveys sent out, (40%) usable responses were received. Â Results show that 30.5% of HMO pharmacy plans allow drug switching. Â HMOs with an in-house pharmacy more frequently had policies that allowed drug switching than those using outside pharmacy services.
Is drug switching safe? Â Well, one study of the Medicare drug benefit followed beneficiaries who were stable on medications but were switched to others by the drug plans providing the prescription benefit. The outcomes were costly and serious. More than one in three individuals had to go to the emergency room, and 15 % were hospitalized.
I understand with the high cost of health care and folks not having insurance, there is a need to do all we can to try and keep cost down. Â I also celebrate all the wonderful advances weâ€™ve made in the areas of medicine and sciences, new drugs, brand name medications as well as generic ones. Â What I donâ€™t understand is a pharmacist, HMOs and insurance companies making decisions without a doctorâ€™s input. Â As I said, drug switching isnâ€™t illegal, but it damn sho ainâ€™t right!
If you or someone you know has been a victim of Drug Switching (therapeutic substitution), please tell us your story. Â Email it to: