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Editor's Note |

Therapeutic Substitution—Should It Be Systematic or Automatic?

Joseph S. Ross, MD, MHS
JAMA Intern Med. 2016;176(6):776. doi:10.1001/jamainternmed.2016.2271.
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Generic drugs are substantially less expensive than brand-name drugs but equally effective. The surest path to generic medication use is for physicians (or other clinicians) to use generic drug names when prescribing. However, many physicians still write prescriptions using brand names, sometimes for no other reason than the brand name is easier to remember or to spell. However, state laws and Medicaid insurance plans generally mandate generic substitution when there is a US Food and Drug Administration (FDA)-approved generic, unless the physician specifically checks the “dispense as written” box. As an example, if a physician writes a prescription for the brand-name drug Zocor, pharmacists can automatically substitute the FDA-approved generic version of simvastatin. When a generic version of a drug is available, use exceeds 85%, with brand-name drug use less than 15%.1

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