Nevada News: Generic Substitution

April 1, 2007 10:59 AM Topics: Prescribing authority and Brand name generic

Reprinted from the April 2007 Nevada State Board of Pharmacy Newsletter.

The subject of generic substitution seems to arise repeatedly in one form or another. With the emergence of the now infamous “$4 generic” the scenario goes as follows: Your patient presents a prescription clearly marked “dispense as written” for a brand name drug (ie, Synthroid^®). Upon learning that the pharmacy has a generic available for $4, the patient demands the generic, even though the physician is known by the pharmacist to insist on the brand for thyroid replacement. The patient argues that it is he or she who is not only ingesting the medication, but also paying for it. Who makes the choice: the physician, the patient, or the poor pharmacist who is in the middle?

The statutes and regulations support the physician having the ultimate authority. If the pharmacist’s request on behalf of the patient for a generic is denied, the patient has the choice of taking the brand name or dealing with the physician directly.