Kentucky OKs dispensing therapeutic alternatives


In an effort to facilitate the ease of patients getting their medicaitons, the Kentucky pharmacy board adopted a therapeutic equivalency regulation allowing pharmacists to substitute drugs within a class with the prescriber's prior approval.



Kentucky OKs dispensing therapeutic alternatives

Kentucky practitioners, on both sides of the physician-pharmacist divide, can cut down on telephone tag thanks to a pharmacy board regulation allowing R.Ph.s to dispense a therapeutic alternative mandated by the patient's formulary with the prescriber's prior permission.

The idea behind the state's new therapeutic equivalence regulation is to make it easier and faster for patients to get the medications on their health plan's formulary. Instead of wasting time chasing the prescriber to approve a drug change, the pharmacist can dispense the formulary's therapeutic alternative with the prescriber's handwritten approval or mark in a preprinted check box on the script.

Since April 4, when the apparently first-of-its-kind regulation took effect, all Kentucky pharmacists have to do is make sure the prescriber checks off a formulary compliance preapproval box on the Rx blank. As an alternative, when the pharmacist calls for permission to select a substitute, the prescriber's approval is entered into the records so there's no need for further contact about dispensing the formulary drug on refill. The pharmacist can adjust the quantity and directions to provide an equivalent dose of the alternative drug. And the pharmacist must notify the prescriber within 24 hours in writing or by fax that the therapeutically equivalent drug was dispensed for formulary compliance purposes.

"Pharmacists have the knowledge and experience, so the board said, 'Why do they have to track down the doctor continually if the doc is looking to treat the patient with a class of drugs rather than a particular drug?'" said Michael Moné, executive director of the state pharmacy board. "The regulation applies to all patients who have third-party plans with a formulary and when the preferred drug is in the same therapeutic class as the prescribed drug."

News of the regulation is slowly spreading through the state's pharmacy and medical communities. The pharmacy board gave its counterparts at the state board of medical licensure a heads-up about the formulary compliance preapproval option. In addition, pharmacy board inspectors are getting the word to pharmacists.

"Our feedback is that people who've seen it, love it," said Moné. "A number of individuals from institutions have been asking how to put it on their emergency room prescription pads. ER docs are notoriously hard to get a hold of, so when they write a prescription that's not on the hospital formulary, the pharmacy has to track them down at 2:00 in the morning. ER docs really like this regulation. In addition, it provides an opportunity for pharmacists to engage in a dialogue with practitioners on why it's a good thing."

Carol Ukens


Carol Ukens. Kentucky OKs dispensing therapeutic alternatives. Drug Topics Sep. 15, 2003;147:34.

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