While written with the best intentions, the legislation currently under consideration by the General Assembly is misdirected. It will interfere with the ability of licensed health care professionals-including physicians, pharmacists, and nurses-to determine which drug agents should be prescribed in the best interests of the patient-consumer.

The legislation would essentially restrict therapeutic equivalency interchange programs (substitution of one medication with another one from the same drug class and having the same pharmacologic actions, producing the same therapeutic outcomes, and having the same acceptable level of risk) and inhibit prescribing practices and the use of formularies. This consequently will result in higher drug costs in health systems. At the same time, it will expose patients to ineffective drugs and ones with excessive side effects.

Additionally, VSHP has responded to an editorial supporting the bill that was published in the Richmond Times-Dispatch on January 17. The Society believes the article was misleading and irresponsible in its depiction and misrepresentation of therapeutic interchange and the drug-product selection process undertaken by health systems.

Key Points about Drug-Product Selection: In talking with your Delegate, emphasize some or all of these advantages to sound drug-product selection processes within organized health care systems:

1. Therapeutic interchange seeks to improve patient outcomes with the cost-effective use of drug therapy. Generic substitutions and therapeutic interchange are acceptable components in providing quality patient care while containing costs.
2. Therapeutic interchange is a collaborative approach, undertaken prior to prescribing, through which interdisciplinary teams that include medical, nursing, and pharmacy staffs, review available drugs-with respect to efficacy, safety, quality of life, and cost-and approve those with therapeutically equivalent effects.
3. Quality of care is the first priority and holds the greatest concern in establishing a well-managed and fully analyzed formulary and/or drug-substitution program in health systems.
4. Within this process, drugs are not arbitrarily or randomly "switched" for financial gain. Approvals for therapeutic interchange are established through a comprehensive review of medical literature.
5. Four primary factors are considered when assessing drugs under consideration, prioritized as follows:
   • Effectiveness for the disease under consideration
   • Side effects of various medications
   • Impact on the patient's quality of life, including the ability to carry on a normal lifestyle
   • Cost of the medication within the context of the overall cost of the treatment episode, including nonpharmacy costs
6. A consumer advocacy "safety net" already exists for programs that are not well-conceived or do not serve the patients' best interests. Accrediting agencies and state boards of pharmacy and medicine have within their respective jurisdictions the authority to take action, thus providing a system of checks and balances.
7. Therapeutic interchange requires physician approval, which protects the patient. Prescribers retain the right to require a specific medication for a specific patient, and always have the prerogative or option to override a therapeutic interchange.
8. Monitoring of patient outcomes against industry-, governmental-, and medical staff-approved practice guidelines reinforces that this approach to disease management has and continues to improve patient outcomes while reducing costs.

Approved by Board of Directors: 02/10/97

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