Well-established laws in all 50 states permit a pharmacist to make a generic substitution unless otherwise directed by a prescriber. In fact, laws in fifteen states—including health care bellwethers such as Florida, Massachusetts, New York, and Tennessee—require that pharmacists substitute generics for brands unless the prescriber specifically orders the brand to be dispensed. Established laws also allow a prescriber to override a generic substitution by writing ―brand medically necessary‖ or ―dispense as written‖ (DAW) on the prescription.

Proposed carve-out legislation would prevent a pharmacist from substituting a generic for its brand equivalent in certain drug classes unless consent is first obtained from the prescriber, even when the prescriber has given no indication that the brand is medically necessary. Some proposals go further and require pharmacists to maintain written documentation of contacts with prescribers to obtain consent. Such time-intensive requirements could cause harmful delays in the delivery of patient care and impose costly administrative burdens on prescribers and pharmacists alike.

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