The AAFP strongly opposes any legislative or regulatory effort at the state or federal level to permit therapeutic substitution, that is the substitution of a therapeutic alternate, a drug product containing a different pharmaceutical moiety, but which is of the same therapeutic or pharmacologic class.
The AAFP opposes the repeal or dilution of any state or national anti-substitution laws or regulations governing the filling of the physician's medical prescription by a pharmacist particularly when a prescription includes a “dispense as written” clarification. Currently, some public and private payers require pharmacists to substitute patients’ prescription medications through policies such as fail first, step therapy, or drug formularies that encourage cost containment without consulting physicians or assessing patients’ medical histories. These policies undermine the doctor-patient relationship by requiring less expensive medications that are therapeutically equivalents. (1988) (July 2023 BOD)