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Members want physician's OK on therapeutic substitution


Some 70% of survey prescription drug users reported concerns about therapeutic substitutions without a physician's consent.

NATIONAL REPORTS-According to the National Consumers League (NCL), a nonprofit consumer advocacy group, approximately 70% of surveyed prescription drug users reported concerns about therapeutic substitution without a physician's consent, although 66% of the respondents were unaware of therapeutic substitution practices, and only 7% fully understood the practice.

"With a wealth of high-quality, low-cost options available today in numerous chronic care drug categories, therapeutic substitution remains a highly viable strategy for promoting the use of lower-cost agents and helping to more effectively achieve balance between cost and quality in the management of a prescription drug program," says David Calabrese, a chief clinical officer with MedMetrics Health Partners and a MANAGED HEALTHCARE EXECUTIVE editorial advisor. "The employment of such strategies should only be done via final signoff from a patient's prescribing clinician."


"While many drug classes offer a wide range of agents with comparable levels of safety, efficacy and tolerability, there often may be clinical nuances associated with specific products within a class that may require a more complete understanding of an individual patient's full medical history and profile before substitution is authorized," Calabrese says.

But what about cost? According to the survey, cost did factor in, but it was viewed as less important by drug users than side effects, doctor's opinion and medical history. In addition, the majority of respondents reported opposition to insurers offering incentives for physicians and pharmacists to switch patients to alternatives. Likewise, the majority of participants (70%) believed that insurers regulate the policies of therapeutic substitution, and a larger majority (77%) reported they would like to see physicians influencing the regulatory process.

"If therapeutic substitution is conducted without appropriate signoff or notification back to the original prescribing clinician, this lack of coordination in care may increase the potential for duplicate therapy, polypharmacy and adverse drug events when that patient returns to the prescribing clinician for follow-up care and that drug substitution has not been documented in the patient's medical record," Calabrese says.

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