Ever since I left pharmacy school to become an accountant, I have trusted my pharmacist more than my md. The RPh has never steered me wrong.

Thanks for the clarification!

We love our pharmacist who is actually in a "big box." He's always been fair and spends time with patients before and after the prescription is filled.

And he always asks before making ANY substitution. I actually thought they had to ask you, that it was the law, because I've always known what I'm getting before I get it.

THis happens because we have allowed(if not given a mandate) to insurance companies to practice medicine and over ride what Drs. prescribe...

As a physician in Illinois, I have run into circumstances in which mail-order pharmacies perform therapeutic substitutions without my knowledge. I only find out about it when the company sends me a letter stating that I approved the change, which is blatantly false, and easily proven when looking at the patient's medical record. Their letter to me then passes the malpractice risk from their company to me.

I have also had pharmacies call me to switch a drug, and I found out that some pharmacists are paid $5 by the pharmaceutical company If I switch a medication to that manufactured by their company, and $3 just for calling me even if I deny the change in medication.

I'll take Anthony Armenti at his word, but stuff does go on behind the scenes that ticks me and my patients off.

I am glad that people have already responded to this misleading article. I'm not a pharmacist, but my father is a pharmacist and toxocologist, and I know a lot about the subject area. Here's the bottom line:

"Therapeutic substitution" has NOTHING to do with swapping *identical* generics for brand-name drugs. Whether intentional or not, the article conflates the two concepts in a very misleading fashion"

"Therapeutic substitution" involves dispensing a related, but completely different compound to the original prescription --- while "generic substitution" is simply dispensing a cheaper version of the *identical drug*. The former is a rotten practice pushed by the profit-crazed insurance companies which can be dangerous in rare circumstances . However, The latter practice is nothing significant at all. Although there have always been myths about generic drugs and people who claim to "feel" a difference, the fact is that generics are highly-regulated and quality tested in the United States to be the *exact* compound and dosage as the brand-name drug.
Many "generics" are actually produced at the same time and in the same factory as the brand-name medication --- the compound is just pressed into a different pill design!

The reason for the "brand-name/generic" situation has to do with how drug patents work. For a limited amount of time after the patent approval of a certain new drug, the company that owns the patent has the sole right to manufacturer and distribute the medication. During this time, a lot of money is spent on branding and marketing the new drug. Once the patent expires (I believe it is 18 years) then other manufacturers have the right to manufacture and sell the drug as well, but due to copyright law, they can't copy the name from the original company. So they just make a generic version and sell it cheaper than the brand-name medication at the pharmacy which many people end up buying. If everything was done correctly (and it is 99.999% of the time), the medication should be identical to the brand-name, just in a different pill.

Wouldn't it make more sense for the pharmacy to dispense the medication that was ordered by the MD?

If a patient is worried about his co-pay, he can ask the Doctor if there is a suitable generic, as the prescription is being written.

By enabling substitutions of "practically" the same medication as ordered by the MD, aren't we letting him prescribe in lieu of dispense?

I say eliminate the substitutions completely. Leave it up to the Doctor, and patient, or AT LEAST force the Rx to inform the Dr. and the patient BEFORE he dispenses the alternative.

Can someone clarify for me if each state has mandates that specify whether or not the pharmacists (including MODs like Medco) are required to have physician and/or member approval to perform theraputic substitution? This article implies that the pharmacy makes that call on their own however that is more likely the case with generic substitution, which is perfectly acceptable if the members plan has a mandatory generic policy and the Rx is not DAW, correct? If it is dictated by state mandates, is there ever a case where theraputic substitution can be happening without physician or member knowledge?

My wife was on a name brand medication, and the pharmacy changed it to generic (they told her). We ended up in the Hospital thinking she was having a heart attack. It seems that the coating on the generic gave her heart burn from hell.

So, I saved $5 on my co-pay for the cheap stuff, then spent $250 & lost a night's sleep in the ER.

I've been ecstatically divorced for twenty years, and this is just now being made known?(grin)

For years, I've had a gut feeling that nutritional healing is much safer. I'll take supplements before anything else. I know for a fact they are!

Today , as an adult stroke survivor, I can and will easily attest that vitamin B works wonders for the brain, red yeast rice is great for cholesterol, CoQ10 is perfect for middle of the night leg cramps and aching muscles. Hot flashes? Take selenium! Nothing beats it!

I wish my parents had never me vaccinated and that I'd never had my kids vaccinated. Most of my life, I'd had too much faith in this government , but it's and the FDA's standards are snake belly low today!

Thanks fellow Pharmacist from New Jersey.

I am a practicing Pharm.D (Doctor of Pharmacy) pharmacist in PA. As i read this article i was enraged by the false statements made multiple times by the author. I am so glad you simplistically clarified the difference between "therapeutic substitution" and "generic substitution".

As a pharmacist I substitute meds within the same class only with the physician's approval, not even the RN or MA. The foremost reason for switching is usually because of third party issues. This article needs to shed more light on insurance companies that have closed formularies and are the primary reason why patients do not get the actual prescribed medications most of the times.

FYI as a trained health care professional we focus on increasing medication compliance and emphasize continuity. If you bring a prescription for Lipitor (considered to be the most potent statin for the treatment of high cholesterol and it's available as a brand name drug only) to my pharmacy and your co-pay is outrageously high, lets say about $50 per month (not far fetched, I have seen copays as high as $100), and you express to me that you cannot afford to pay for it and decide to go home without it; would you prefer that i call your physician to prescribe an alternate statin which is on your insurance formulary and with a lower copay as little as $5 depending on your plan, or let you walk away knowing fully well that you are not taking your medications, hence jeopardizing your health. I will choose the former for me, likewise for you.

That's what we are trained to do. Look out for the health of the people that trust us to care for them.

Amen to everything you wrote! Also, it would be nice to make people aware that the PHARMACY has to jump through so many hoops all day long imposed by the insurance company. Our jobs would be sooooo much easier if we could just fill what the doctor wrote for. However, due to insurance companies restrictions, we have to call doctor's offices to request what the INSURANCE company requires. The pharmacy can't just "change" the medication without the doctor approving that change. So you call the doctor, end up on hold forever, leave a message, and then wait, maybe DAYS, for them to get back with you about it. In the meantime, you have the patient waiting on their medicine, calling every day, wondering why the PHARMACY won't give them their medicine!

Good work Pharmacist Armenti,

This article by MSNBC meets the new standard for "Health News": Titled to create alarm, mixed and confused information, and implications of impropriety by healthcare professionals. Yup, its got it all!

The silliness we retail pharmacists deal with on an hour to hour basis is exasperating: prior auths for cheap generics, uncoordinated "step therapy" edits and the opportunity to deal with helpdesks often (not always) staffed by people who can just repeat verbally the electronic rejects.

If you wonder why prescription service seems slow, look no further. Patients who deserve special attention get it at my pharmacies, but service to others is naturally affected.

The learned comments by physician colleagues here give some flavor of the complicated morass we deal with daily.  What a mess!

Thank you so much Anthony, from New Jersey, for so eloquently clarifying the many discrepancies of this article. I tell myself that maybe those outside of the healthcare realm do not fully appreciate the consequences and risks articles such as this pose for patients who may decide to immediately stop taking their medicines. I have seen this first hand and it is very disconcerting. As a pharmacist, I found it offensive and hard to believe a story such as this could be published without getting ALL of the facts straight beforehand.

I am a fourth year pharmacy student. Pharmacists are the most trusted healthcare professionals. This article is outrageous and something should be done to combat this type of press reaching the general public!!!

I have had to go through issues with my insurance over a possible substitution for Lexapro - or should I say my doctor did. She faxed back and forth with the insurance company nearly half a dozen times to make them follow her directions. (I actually work with the same company where she practices so I was aware of it.) In my experience, it's pretty much the insurance companies that are causing the problems.

I love my pharmacists. They're so knowledgeable and eager to help, and they're fantastic about keeping an eye on my med combos. They even tell me when they're substituting a generic in place of a brand name.

There is no excuse for any pharmacist ever substituting generic drugs for namebrand drugs when it comes to conditions like epilepsy. Regardless of the law that allows pharmacists, to quietly pretend they are giving the patient the real prescription, the pharmacist has a moral obligation to put the patients safety first, and alert them if they are going to be making unofficial medical changes.

Tegretol is one of those medications that has a high incidence of failure when patients are switched from brandname to generic (or vice-versa), or even from generic to generic. Namebrand tegretol controlled my seizures wonderfully - no problems or side effects at all. Then the insurance changed, and without telling my parents or my doctor, the pharmacist filled my prescription with generic. I was constantly dizzy, irritible to the point of hitting people at every imagined transgression, and engaged in several suicide attempts. I had no choice but to switch to dilantin - a medicine with scary longterm side effects. I was only on it for a year - my gums bled when i brushed my teeth, most of my hair fell out, I could barely stay awake for the whole school day. But it was better than generic tegretol and I was allergic to the other options available for partial seizures at the time. I went from A student to D/F student after losing my namebrand tegretol, and I didn't start getting A's again until after I was off the dilantin.

My epilepsy returned last year. Luckily now Keppra is available - it wasn't when I needed medicine before. It still doesn't work as good as the namebrand tegretol worked when I was 14, but Medicare won't allow me to have namebrand tegretol until I've failed generic for several months, and my past medical records show that I shouldn't be on the generic. It would be nice to have the seizures stopped but I can't do that if the pharmacy refuses to give me the medicine that my prescription is for.

In December, I went to Eckerd drug with a prescription for namebrand keppra, handsigned by my doctor, with "Do not substitute" written on it. Not only did the pharmacy give me generic keppra, they changed the dosage of the pills prescribed because the dosage on my script hadn't yet came out in generic form. And for the first time ever, they put my medicine in a bag. They folded the bag closed as they handed it to me. My doctor had warned me that even though it was illegal for them to be giving me generics, most of her patients who needed namebrand medicines had been handed generic at the pharmacy and I was not to accept any generic keppra. I refused the medicine, telling them that they weren't allowed to give me generic,. and came back a few days later - they no longer had any copy of my prescription, then told me it had been written for the dosage they had changed it to in order to force the generics on me (which I knew wasn't true because that would have required me taking 6 pills a day, and my doctor took the time calculating which dosage would give me both the lowest number of pills to take, and be the easiest for me to increase without getting a new prescription).

The only thing outrageous in this article is that people aren't believing this. There are those of us with medical reasons for namebrand medicine that are being handed generics (often times illegally) by pharmacists. Go to the Epilepsy foundations website - stories like the one the article opens with are pretty common. Epilepsy drugs have a 12-19% failure rate in double blind studies when patients are switched from namebrand to generic, or generic to generic. Other drugs have a 1-2 % failute rate. The FDA has NEVER ONCE used an anti-epilepsy drug in the studies they cite to prove that there is no discernable difference in effect between generics and namebrand.

Namebrand, generic, and different versions of generics all work slightly differently. In my case, my allergies are mostly the reason i can't take generics (or most namebrands for that matter). A switch to a generic medicine that takes an hour longer to kick in may not be a big deal for a problem that you can monitor, see you are getting near a problem, and take action to stop it from occuring (ie blood sugar), but with epilepsy its either total seizure control or no seizure control. You can't say "hmm, I feel like I might have a seizure later on." You have the seizure. If I don't take my keppra within 30 minutes of my scheduled time, I'll have a complex partial seizure that typically takes me 2 days - 1 week to fully recover from. You can lose your drivers license between 6 months - 2 years each time you have a seizure (depending on where you live), and it only takes one pharmacist substituting your namebrand prescription with generic drugs to cause you to have a seizure - there is a person on the EF boards who was 10 years completely seizure free before the pharmacist gave her generic meds. She had seizures within 3 days of taking the generic. No drivers license, ambulance bill, hospital stay, EEG and MRI costs - all because the pharmacist didn't fill the prescription for the medicine the doctor prescribed.

I guess it does depend on the state. I did receive a different antibiotic once then prescribed: since the "brand" was still patented, the "generic" was a different macrolide.

It was "close enough" in this case, but one has to be careful and do their own research. Life must really suck for people with no medical background when dealing with healthcare system. Doctors are horribly overburdened, bureaucracy of the system is insane, and the probability of "falling through the cracks" is really high these days.

As a physician in Illinois, I have run into circumstances in which mail-order pharmacies perform therapeutic substitutions without my knowledge. I only find out about it when the company sends me a letter stating that I approved the change, which is blatantly false, and easily proven when looking at the patient's medical record. Their letter to me then passes the malpractice risk from their company to me.

I have also had pharmacies call me to switch a drug, and I found out that some pharmacists are paid $5 by the pharmaceutical company If I switch a medication to that manufactured by their company, and $3 just for calling me even if I deny the change in medication.

I'll take Anthony Armenti at his word, but stuff does go on behind the scenes that ticks me and my patients off.

I have never "heard" of this practice of pharmaceutical companies paying a pharmacist to switch a medication to preferred for a cash exchange. It is rash to make judgements on hearsay, or if true blanket this statement to all pharmacists. The same can be said of the past when physicians were given vacations, and extravagant gifts to prescribe one drug over another. So even if this statement were true, no one profession can claim to be innocent of being swayed by the mighty dollar.

I think this article is false, and grossly inaccurate. It is an extreme example of poor journalism. The statements given by the people in the article are opinions and hearsay, I also think it's interesting that not one pharmacist is cited in the article. If the author even made a small attempt at fact checking a pharmacist, intern or technician could tell you that it's incorrect.

I agree with Mr. Armenti that I am tired of pharmacy being the scapegoat for insurance companies or patient dissatisfaction. The local pharmacist do not determine what drug will or will not be paid for by your insurance company. I do not want to place blame because the problems in healthcare are so vast, but if one had to choose it may be the PBM, not the local pharmacist. This statement by Dr. Renker that a big chain may be more honest is quite laughable. If anything big chains like Walgreens and CVS/Caremark have more motivation to make substitutions because they have their hand in dispensing and PBM's. This practice of slashing generic prices is noncompetitive to independents, and is making it so that the only person who has a chance of surviving are big chains. Big chains can wait months to get reimbursed, and do the volume that can survive getting paid pennies for prescriptions.

As a student, who is graduating from pharmacy school next week. It frustrates me that physicians and often patients feel that we are not on the same team with good patient care being the goal of practice.

Insurance companies do not just regulate the drugs you take. My cousin is a surgeon and she is so burned out fighting with insurance companies over MEDICAL TREATMENTS that the insurance companies will and will not pay for - even if they are in the best interest of the patient. She really loves her job and her profession and her patients but she is so tired of fighting and often thinks of leaving her practice.

We had a very quirkly "rule" in our insurance company that created a big, expensive problem for us. My twins were preemies and their speech was delayed. It was not delayed enough that they fell under the birth to 3 program in our state. So, we were left to find private speech therapy on our own.

Our insurance company would only pay for restorative speech therapy. Meaning, our insurance company would only pay for therapy for my children if they actually HAD speech and lost it (from a stroke, for instance.) Since they never had it, they would not cover it.

God love our MD, he fought and fought for us but could NOT get the insurance company to cover it. He was frustrated by all the calls but we were glad he fought to help us.

So, we were left to our own devices.

Private speech therapy out of pocket would have cost us several hundred dollars a week - money we did not have. We were forced to come up with an alternate plan that included speech immersion. It worked. Thankfully.

Because we have given that power to insurance companies.. bizad majors make medical care decisions...soemtimes contrary to the physicians direcrives..

All these people who are against universal healthcare in this country scream that the government will be making your helthcare decisions for you, not you and your doctor. Well guess what people, with the current system you're not making your own health care decisions anyway. The insurance companies are deciding for you what course of action you will take by telling you what treatments and medications they will or will not pay for.

The reason insurance can do this is due to the golden rule. Those with the gold, make the rules.

It's completely and totally frustrating.

This story is so blatantly biased towards drug manufacturers that a 2nd grader could see through this. Does this have anything to do with the proposed laws that prevent pharmacists from generic subbing anti-epileptic meds unless they check with the doctor even if the doctor signs that generic subbing is permitted? I think so. Just more red tape for someone to get rich doing nothing.

Meanwhile, pharmacist, who are on the front line of healthcare, continue to take a beating financially.

Certainly was consistent with my experience ..regarding friends, relatives and me

Oldpopulist- What is your experience? In CT, no pharmacists can change your medications without doctor approval. The only switch we can make is generic substitution, replacing a brand name drug with its own generic. We cannot replace a brand name drug with a generic of a different medication within the same class. For almost all patients, this isn't a problem. For a select few, an inactive ingredient in the generic can cause a reaction. This can happen with brand name drugs too, if a patient doesn't tolerate the brand name they might tolerate the generic.

I've taken lots of meds both generic and brand over the years - including tegretol - and have never had a problem. Except in the rare cases of reactions to excipients (ingredients other than the active ingredient in the pill), most people tolerate generics just fine. While the FDA requires manufacturers of generic drugs to prove that they are bioequivalent, there have been lots of "consumer groups" challenging that the drugs are in fact equivalent. When the FDA has investigated their claims (like for antidepressents that supposedly did not have the same dissolution rate), the claims have been unfounded. It's possible that the woman taking the generic tegretol was not fully adherent to her medication schedule...

Also, the list said that if your doctor prescribed Lexapro, you might get citalopram. No, you wouldn't, because citalopram is the generic of Celexa, and a pharmacist would not be allowed to switch from one antidepressant to another without the prescriber's permission. If your pharmacist is doing that, report them to the state.

Marissa,

Do you remember when that law was passed? I have not had problems recently, but a number of years ago I came across several instances of therapeutic substitution (i.e to a completely different but related drug) without my authorization, and all of them were from local pharmacies here in MI.

Granted, the vast majority of pharmacists will call before doing this, and I have no problem switching drugs in the same therapeutic class so long as the same relative potency, vehicle type, and so forth are involved. I want my patients to save money, too! But I prefer that the pharmacist calls me to discuss the issue first, i.e. " This drug is not on the formulary, could we change to X or Y?" or "This drug is going to be a third-tier co-pay, and the patient wants something cheaper--can we change to X or Y or Z?" I also have no problem with generic substitution of brand name drugs in most cases, and very rarely write anything as "DAW" as a result. Believe me, the drug reps know I'm not a big money-maker for them.

The instances of inappropriate therapeutic substitution I can remember off the top of my head were:

1. Hydroxyzine HCl being dispensed in place of Zyrtec (back when Zyrtec was still brand-only and Rx-only) for an elderly patient in whom Atarax previously caused too much sedation. These drugs are certainly closely related, with cetirizine being an active metabolite of hydroxyzine, but they are not interchangeable--sedation is much more severe with Atarax in most patients, the duration of action is shorter, etc. To make this particular substitution without calling first, especially in an elderly patient, was shocking to me. No one had called my office to speak with me, or even with one of the staff, before dispensing the Atarax. I only discovered the switch when the patient brought in all his meds in their original bottles.

2. Vehicle issues:

a) Clobetasol ointment dispensed in place of Olux foam. Yes, both are clobetasol 0.05%, but this was a case where the vehicle was an extremely important issue, in a patient of European descent with seborrhea. Olux would not make her hair greasy at the roots while being applied to the skin of the scalp, but the ointment is another story. (While many patients of African descent may prefer the ointment to the foam for scalp use, very few Caucasian patients will willingly use a greasy medication to the scalp, even bald men.) Again, no call from the pharmacist to see if I would be OK with the generic clobetasol solution, which would have been a much better alternative for this particular patient. The only phone call I received was from an angry patient the next morning, wanting to know why I prescribed "that Vaseline glop" for her scalp.

b) About 2-3 times per year I used to come across this scenario: Generic clobetasol ointment was prescribed for an African-American patient who happens to use heated instruments to straighten her hair, followed by a greasy pomade (to exclude water from the newly-pressed hair shafts, maintaining the new straightened conformation.) The pharmacist instead dispensed clobetasol solution, which would put alcohol and water onto her scalp in the application process. The patient would get upset and call me about how her new medication caused her roots to kink up, making her freshly-styled hair hard to manage. This is especially frustrating for a patient who has just spent time and money at the salon to have her hair pressed. Each time, when I called the pharmacist to see why the switch was made (since insurance companies should have no problem paying for the generic ointment or the generic solution,) I was told they did not have the ointment in stock at the time, so they dispensed the solution. Had the pharmacist called me, or even just asked the patient which she would prefer, the problem could have been avoided. Most seborrhea patients would rather wait a day or so for an order to be delivered from the wholesaler, rather than spend the money for the co-pay and then find they cannot used the drug that was dispensed.

c) Clindamycin solution dispensed in place of clindamycin lotion. Some unfortunate patients have both eczema and acne. I specifically want the lotion for these patients as it is less drying. Yes, the solution is cheaper for a cash patient, but if she can't tolerate the vehicle, the drug will sit on her bathroom counter, unused. That does not save her any money. This used to happen to my patients all the time, even if I underlined or circled the word "lotion," or put an out-of-place "DAW" on this otherwise generic Rx. Come to think of it, this still happens about once every month or so. And don't get me started on the insurance companies that mandate the torture of these same eczema-plus-acne patients by forcing them to try tretinoin 0.025% cream (or even the slightly less drying but more expensive Retin-A micro 0.04%--if it is on the formulary) before they will pay for non-formulary Differin 0.1% cream....

3. Topical corticosteroids from one potency group (class 1 through 7) being substituted for another. If I write for Vanos (class 1) and there is a formulary issue, co-pay issue or "I don't have it in stock" issue, I don't mind a phone call to see if another class 1 drug such as generic clobetasol or generic diflorasone can be substituted. I do mind if the patient has thick psoriatic plaques on his elbows and is just given some class 3 triamcinolone acetonide 0.1% cream without asking me first, because it will be less effective. Likewise, if I write for class 6 desonide cream for a baby with eczema, and class 3 TAC 0.1% is dispensed, I will be downright angry--my patient has been put at risk of atrophy! Even within the same or adjacent potency classes there can be vehicle issues: If you want to dispense a class 3 or 4 TAC 0.1% in place of class 3 Cutivate ointment, that is usually OK...but if the patient has significant crusting or loss of barrier function, the cream will sting while the ointment will be soothing, so class 3 TA ointment 0.1% would be a better choice than TAC 0.1%, and I would prefer a phone call to discuss the issue first. But I have had all three of these things happen, and no phone call was made by the dispensing pharmacist.

4. Topical corticosteroids from one allergy group (groups A though D) being substituted for another. Rare patients cannot use specific steroids because of an allergy to the active ingredient. If my patient has an allergy to group B topicals, and I write for fluticasone ointment (in group D) to avoid an iatrogenic contact dermatitis on top of whatever rash the patient originally presented with, substituting TAC 0.1% is not acceptable. Granted, the pharmacist may not have considered a class-wide allergy despite this patient's documented history of a reaction to Synalar, and I made that mistake exactly once; since then I have also written "No group ___— topicals--patient is allergic" when I have a patient with a topical steroid allergy. But still, a phone call about the therapeutic substitution would have been nice.

5. Preservative issues. There are patients who can use brand-name Locoid, but develop contact dermatitis from TAO 0.025%. Don't get me wrong--I love TAC/TAO 0.025 % and 0.1% and write for them all the time; they are effective for many dermatoses, usually in stock at every pharmacy, and on the $4 generic list at many chain stores. But if a preservative allergy is present, the patient may need Locoid or some other DAW brand-name Rx. Likewise, I will sometimes ask for TA powder to be compounded into preservative-free petrolatum to a final concentration of 0.1%. The specialty compounding pharmacists always dispense this as requested, as do most other community pharmacists, but I have had 2 cases where patients were just given a commercially-made TAO 0.1% off the shelf despite the request for a compounded one. If the DAW Locoid or compounded TAC will be too expensive, please call before dispensing something else. I have no problem discussing other options, and the pharmacists know better than anyone which other commercially-made products might lack certain problem preservatives. Please educate me about my other options! If generic X has a better vehicle than generic Y for a specific patient, then off-the-shelf Y may be just fine, and the compounding can be skipped.

So I have not seen most of these problems recently in MI, but I certainly came across them in the past.

Pharmacy Pirate, you're an idiot. You just contradicted yourself. If you took the time to read above, you would have figured that out. This case IS private healthcare doing EXACTLY what you're complaining about. The drug companies will never pay for the new stuff. The government will and does. In England, the NHS allows the use of new and experimental medication, particularly when no other option will help. It saves peoples lives. Insurance companies don't - because its cheaper for them to face lawsuits and let the person die then pay for $500K in new forms of treatment. This is not to say that universal health care is all cozy either. Without those profits in private healthcare, research cannot be performed to the same degree because the money simply won't be there. That is of course, until this year when the stimulus package gave the NIH billions of dollars to dish out and mandated that all grant submission be AT LEAST 1.5mil in requested funds (check my number, but its somewhere around there). This is previously unheard of. And guess what, thats the government picking up the bill. More money there than even private healthcare can do. This of course relies on the gov't doing every year which is impossible with our spending patterns. Take defense. Why spend a few trillion dollars on defense when the future of warfare will have nothing to do with how big your gun is or how fast your missle. It'll all be bio-warfare. And there's not a single weapon that can stop such a threat. All we need to do is give the ILLUSION that we're big and bad because World War III will never happen because everybody has many allies and guns will get no where. So who do we turn to for such a future? Oh wait - bio means medical!!! Guess what, start spending more on medical research and less on the next explosive materials. Of course that'll never happen as long Hali-hurtin', Northrop Grumman, Lockheed martin etc. etc. are still around lobbying for useless spending. Wake up people and think before you walk out of the house in the morning.

It's actually $1 mil over 2 yrs. They wanted each funded study to use the funds and provide results in a more timely fashion than previously accustomed to. I think it's a great plan.

Please look further into my statement...I am simply pointing out that a liberal company (that supports universal healthcare, as I do...) should never have published an article that basically supports private healthcare and Big Pharma.  This is an unusual article for MSNBC to publish...

touche. However, I disagree with censorship. I'm certainly left aligned (some may say far left, but I'm more fiscally conservative which brings me back more center), but I have no issue with anyone publishing anything as long as its legal to do so (ie not in confidence, or slanderous) and is true and accurate. This article, politics and personal opinions aside, is a disgrace to the profession of journalism, let alone pharmaceuticals. If I were a pharmacist (I'm an architect) I'd be pretty pissed off. It is clear this guy doesn't know what pharmicists do or that they are requrired to have 6-yr professional medical degrees in order to enter the field. They are the drug experts. Physicians know relatively very little on drugs, their effects, their reactions/conflicts (with other drugs) and dosing compared to pharmacists. I'll stick to the nytimes, thank you. Even if they too are slanting one way and have been writing shoddy articles lately as well. None of them, however, compare to this.

Wake Up and Smell the Doses - YOU are the idiot. The government CAN and DOES mandate therapeuctic subs and generic switches in order to pay for medications. Check out medicaid rules and regulations!!!!!!!

rcmcrph2, check response by dr. di. Generic = ok. Its the exact same thing (same formula, just no longer under a protected patent). Nothing wrong with them. Not sure about theraputic subs - check the same response. Then think about what you just said and do some research. Medicaid is an underfunded and pethetic excuse for socialized healthcare help. If a socialized healthcare system were to be implemented here, it would unquestionably have to be better then anything this gov't has offered before. That of course depends on which party is running the show. Then reread my statement. I never said one system is better than the other in my statement (because neither one is) - I only listed pros and cons and a rebuttle to one of the socialized systems' potential areas of failure. Given that you failed to read the rest of my answer, I must have struck a chord elsewhere.

So was it the fact that socialized anything was depicted in an arguably positive light, or the fact that I said the world is ultimately doomed anyway that got you? Cause if you want to go there, pharmacy, medicine, and the denial of natural selection and evolution will ultimately render our race extinct in the near future. This is not to say I have anything but respect for the medical profession (i'm practically married to it), but MRSA et al exist for one reason. Medicine.

An allergy like this should be made known to the pharmacist so they can check inactive ingredients in all medications being dispensed. It is just as possible that a brand name medication would include the same ingredient your wife reacted to. If you are concerned, you can always ask the pharmacist for the package insert to check all of the ingredients yourself.

Insurance company...no...but when you practice in rural America like myself and Mrs. Jones draws $700 a month and she is prescribed a medication that is gonna cost her $200 a month and there is another that is therapeutically similar and cost $15, Mrs. Jones really appreciates the pharmacist making the effort. I see at least a 99% success rate in therapeutic substitutions which are ALWAYS authorized with the physician. My pharmacy has saved individuals thousands of dollars over the years without compromising their health. Remember, the pharmacist is not an uneducated assembly line worker as this article would like for you to believe.

Generic drugs made in foreign countries are regualted by Food and Drug Administration.

You are another uninformed consumer. Open your eyes and do some research.

The FDA doesn't even have time to properly monitor the manufacturers in the US much less the ones overseas. All the heparin deaths from the manufacturers in Tennessee and China are proof of that.

So do you only eat food made in this country, wear clothing made in this country? Come on, half of the brand name drugs and most of the ingredients in the brand name drugs come from India. I've been taking generic Celexa for years with no problem. People like you are part of the reason that health care is so rediculously expensive in this country.

No its the guys who lobby congress and then deal with the insurance cos that make health care so expensive. A generic only has the main ingredient the same as the name brand, all the fillers may be diff and thats what causes the problem, speaking from experience here. No the drugs coming from overseas are nor FDA regulated, you can check that out.

HMOHeadache, the government DOES regulate manufacturers overseas. They barred importation of several medications made by a manufacturer overseas (It may have been India actually, I read about it on the FDA's website in November) due to the fact that they didn't comply with good manufacturing practices.

I did not know the drug reps were hitting on the pharmacists as well. The problem is even worse than I thought. Thank God there are still some doctors who don't consider prescriptions to be a profit center in their medical practice.

hg1234 - I didn't mean to specifically single out "pharmaceutical companies." I'll correct my statement in that the pharmacies were paid $5/$3 by "someone" - it could have to do with the particular contract a pharmaceutical company or insurance company or pharmacy benefit manager signs with a chain pharmacy. And doctors do not profit from prescriptions they write. There are no direct kick-backs. Doctors can be paid by pharmaceutical companies for doing lectures, etc., promoting a particular medication. I do not know if the $5/$3 example I used is still being done, but it sure P.O.'ed me at the time. I agree with most of the comments by the numerous pharmacists who have commented here, I'm sure the vast majority of whom practice ethically. I also have to say that most of the article is pretty accurate too, albeit with a slanted-view. The problems I've had with therapeutic substitutions without my knowledge have come from mail-order companies (not the corner pharmacy). Generics are very often appropriate, but it comes down to the individual patient's situation, and brand names are required in various situations also. BTW, I'm in Illinois so laws here may be different than in other states.

I am a pharmacist in Illinois and I know I will only contact the doctor to inquire about switching medications if the prescribed medication is not covered by the insurance company or is covered with an outrageous copay. I almost always contact the patient and ask their permission to call the doctor about prescribing a different medication (I've occasionally called and asked if a different medication could be tried in the case of time-sensitive medications, such as antibiotics, without first conferring with the patient, but I leave the option of the original expensive medication for them in case they prefer the first choice). If a pharmacy is switching between medications in the same class, that is blatantly illegal in Illinois, but every pharmacist I know would never switch a medication without theprescriber ok.