Doctor’s orders may not be followed at pharmacy or by health insurer

A Team 4 (Pittsburgh ABC affiliate) investigation found the drug your doctor prescribes may not always be the exact same drug you get at the pharmacy:

While it’d be nice to think that drug switching has stopped since the airing of this investigation November 2009, more than 80% of you readers say it is happening today and almost the same percentage of doctors and patient advocates concur.

The National Consumers League conducted a survey and found two out of three people who had their prescriptions switched never were told.  The NCL is not describing switches to a generic equivalent, but rather a switch to another drug within the same class of drugs, and provides some examples (I paraphrase and of course this is not medical advice):

  • Cholesterol: Prescription for Lipitor, but patient given Simvastatin (generic equivalent of Zocor, another statin). Both drugs are treating cholesterol but in different ways: Lipitor is better at lowering LDL and triglycerides, but simvastatin is better at raising HDL cholesterol.
  • Anti-depressant: Prescription for Lexapro, but patient given Citalopram (generic version of antidepressant Celexa). Patient could experience more side effects with citalopram. Lexapro is more concentrated, so it’s prescribed in smaller amounts.
  • Hypertention: Prescription for Diovan, an angiotensin receptor blocker for lowering blood pressure, but patient given Lisinopril (generic equivalent of Zestril), an ACE inhibitor for lowering blood pressure. Patient on lisinopril may develop a nagging cough.
  • Heartburn: Prescription for Nexium, a proton pump inhibitor, but patient gets Omeprazole (generic equivalent of Prilosec). Patient may experience more side effects with Omeprazole.

As Sally Greenberg, executive director of NCL explains, “We believe that if a patient is switched from one drug to another that it should not be legal unless the patient and the doctor have been informed and are on board with the switch.”

Ms Greenberg’s point is a good one. While one would not think that such a process would be necessary, clearly one is required, because pharmacists and insurers may not be “playing nice”. After all, drug switching is like going to a restaurant, ordering fish and instead getting steak. Now the steak may have been just as good, worse, or the same as the fish. However, that’s not the point. The waiter should probably have said something before serving the food.

More importantly, for the health and safety of the patient, there is the patient and the prescribing doctor who should be consulted and give their approval before a drug switch occurs.

In the survey which I ran, 96.2% agreed with the following statement: “Therapeutic substitution, which switches a patient to a different drug, should only be done with the full knowledge and consent of the prescribing physician and the patient, and as a result of a discussion between them.”

Do you agree?

3 Responses to “Doctor’s orders may not be followed at pharmacy or by health insurer”
  1. See this all the time with patients and their home medicines. Seems almost as if we should call it practicing medicine without a license. And isn’t that a crime?

    • Michael Wong says:

      Interesting point, Nerdy Nurse. Although not wise for people to self-medicate, they are (for better or worse) doing it to themselves. Sadly, in a way, their own perogative. In drug switching, it’s someone else doing it without their or (more importantly) their doctors’ consent.

  2. oh I was refering to our pharmacy in switching their home meds. Surprisingly, most of the patients I encounter state they take most of their medications are prescribed “when they can afford to”

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