What is required for a pharmacist to substitute a drug product?

For a pharmacist to substitute a drug product, it is essential that the prescription specifically does not indicate "no substitutions." This means that if the prescriber has not prohibited substitutions — either verbally or in writing — the pharmacist has the authority to substitute a prescribed drug with a therapeutically equivalent alternative.

This practice is grounded in the goal of providing more cost-effective options for patients without compromising safety or efficacy. In many states, including Alaska, pharmacists are empowered to make substitutions as long as the therapeutic equivalency is verified and the prescriber has not explicitly stated that the prescribed drug must be dispensed as written.

While obtaining the patient's verbal permission may be a courtesy, it is not a legal requirement for drug substitution. The requirement of discounts for substitutions is unrelated to the legal parameters under which a pharmacist can operate and is not a standard practice in most pharmacies. Lastly, although a written prescription is necessary for any prescription medication, it does not pertain solely to the reason for substitution; it is a fundamental requirement that applies to all prescriptions. Therefore, the statement regarding no substitutions directly addresses the conditions under which a pharmacist may proceed with drug substitution.