State Approaches to Therapeutic Interchange in Community Pharmacy Settings: Legislative and Regulatory Authority

Therapeutic interchange is the act of switching a prescribed drug for another drug in the same therapeutic class that is believed to be therapeutically similar but may be chemically different. Therapeutic interchange is different from generic substitution in that it does not occur between therapeutically equivalent products; instead, products are substituted for those that are likely to have a substantially equivalent therapeutic effect generally at a lower cost. Therapeutic interchange is common in institutional settings across the United States but rarely occurs in community pharmacy settings without a pharmacist first contacting the original prescriber and requesting a new prescription in order to facilitate a change. As of 2018, Arkansas, Idaho, and Kentucky have passed laws to enable therapeutic interchange in community pharmacy settings. In general, these laws require the original prescriber to opt-in to allow therapeutic interchange, and the pharmacist generally must leverage the formulary of the patient’s health plan to guide decision making within the same therapeutic class. These 3 states require that the pharmacist notify the original prescriber of any interchange in order to ensure a complete and accurate medication record. When appropriately structured, state laws enabling therapeutic interchange in community pharmacy settings allow pharmacists to use their medication expertise to save valuable time and enhance patient care while reducing health care costs.