Table 2

Drug-Substitution Laws Applicable to U.S. Patients

Type of Law

States and Territories


Mandatory/permissive substitution:

States generally either permit or mandate that the pharmacist substitute a generic version of a prescribed drug if all prescription requirements are met.

Mandatory: FL, KY, MA, MN, MS, NJ, NY, PA, PR, RI, WA, WV

Permissive:

    AL
, AK, AZ,
    AR
, CA, CO, CT, DE, DC, GA,
    GU
, HI, ID, IL, IN, IA, KS,
    LA
, ME, MD, MI, MO, MT, NE, NV, NH,
    NM
,
    NC
, ND, OH,
    OR
, SC, SD,
    TN
, TX, UT, VT, VA, WI, WY

State Drug Formulary: Some states provide a positive (drugs are equivalent and interchangeable) or a negative (drugs are not equivalent and not interchangeable) formulary to guide appropriate substitution.

Positive: DE, DC, FL, HI, IL, MA, NE, NV, NH, NJ, NY, TN, UT, VA, WI,

Negative: AR, KY, MN, MO, NC

Patient consent/notification requirement: Most states require patient consent for, or notification of, substitution.

Required: AK, AZ, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, ME, MD, MI, MN, MS, MO, MT, NE, NV, NH, NY, ND, OH, PA, PR, SC, SD, TX, UT, VT, VA, WV, WI, WY

Not Required:

    AL
,
    AR
,
    GU
,
    LA
, MA, NJ,
    NM
,
    NC
,
    OR
, RI,
    TN
, WA

Cost savings requirement: Most sates require that the drug dispensed be less or no more expensive than the drug prescribed and that some of the cost savings be passed on to the purchaser.

Less or no more expensive: AK, AR, CA, DC, GA, GU, HI, ID, IL, KS, KY, ME, MD, MA, MS, MO, NV, NH, NJ, NY, NC, ND, OH, OR, PA, PR, RI, TN, TX, VT, VA, WI, WY

Savings passed on: CO, CT, DE, FL, IN, IA, ME, MD, MI, MN, MT, NE, NM, RI, TN, WA, WV

Requirement not mentioned: AL, AZ, LA, ME, PR SC, SD, UT

NTI drugs recognized as special category

Recognizes NTI: KY, NC, PA, SC, TN


Boldface states and territories = mandatory generics substitution without patient consent/notification

    Underlined states and territories
= permissive generics substitution without patient consent/notification

NTI: narrow therapeutic index

Adapted from [47-49]

Liow BMC Neurology 2009 9:11   doi:10.1186/1471-2377-9-11

Open Data