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 |