Mandatory Generic Drug Substitutions

In states with laws supporting the mandatory substitution of medications, generic medications can be given in place of the name brand without notifying either you or your doctor.

States where this is not mandatory often offer you the choice of taking either the name brand or prescription drug.

The theory behind these laws is that pushing the lower cost generic medications will reduce overall healthcare costs.

However, these laws have raised concerns because the sudden change in medication can affect certain paitients, such as those on epilepsy or thyroid medication.

The best chart I could find that breaks down each state and its individual requirements for generic substitution is found on an "Epilepsy Proffessionals" website.

This site lists the following states as having mandatory substitution of generic medications, as of 4/25/07:


1.Florida
2.Hawaii
3.Kentucky
4.Maine
5.Massachusetts
6.Minnesota
7.Nevada
8.New Jersey
9.New York
10.Rhode Island
11.Tennessee
12.Vermont
13.Washington
14.West Virignia

Keep in mind, state laws change often, so if you are curious about your state, ask your docotr or pharmacist, since they must have up to date information.

One month I went to the pharmacy to pick up my monthly refill of thyroid medication. I went to the counter and the pharmacist says, "A generic version has become available so we gave you the generic."

I was a bit dumbfounded as to why they had automatically filled the prescription using the generic drug without telling me. I said, "I have always taken the name brand, so why did you switch it?"

Her response was,"It's cheaper."

So I asked, "You don't have the name brand? That's what I was prescribed."

She replied, "Well I can get you the name brand if you really want it."

I told her I did want the name brand prescription I had always taken and was not going to switch without talking to my doctor. She finally went back and got me the name brand.

Fortunately, I had an appointment with my doctor for a check-up the following week. When I explained to him what had happened, he immediately got concerned and said, "You did not switch your medication did you?" I reassured him I hadn't. He then proceeded to tell me that an approved generic substitute for the thyroid medication I was on had just gotten on the market. In our state, pharmacists, by law, could change prescriptions to generic without notifying either the patient or their doctor. I had never heard of such a law. He said that he had had several patients call complaining of symptoms, and on investigation, they found their thyroid prescription had been changed. The generic drug works differently then the name brand when in the body, and their dosages had to be adjusted. He said I was fortunate that the pharmacist had said anything beacuse by law she didn't have too.

Before I left he gave me a prescription with the proper "no substitution" phrase so that it would not happen again.