Pharmacy Laws

A wanted to check with you guys, isn't it against the law for a pharmacy to substitute a drug without informing the patient? I'm not concerned with going from name brand to generic for this discussion(although I think they have to tell you then too) but I'm talking about them switching you from one generic to another.

Background to the situation:
My wife and I are expecting our first child together in June. My wife has Celiac disease which means she can not have gluten. Gluten is common in wheat and other grains and typically serves as a binding agent.
As my wife is pregnant, she needs a prenatal. Her doctor wrote her a prescription that literally said "gluten free prenatal."

So the other day I go and pick up a new bottle of her prenatal from the pharmacy, when I get home she goes to take it and sees that the pills do not look the same. She checked the bottle and it was a different prenatal. This prenatal is not gluten free

So:
A) I think the pharmacy broke a law by not telling me they substituted another drug for the one they had been dispensing to us for 3 months
B) The pharmacist checked off on a drug that was not what the perscription called for.

I don't think so but, they should refund what you did get since it is not gluten free and was a design condition of the prescribed drug.

I think you get notified by the lengthy drug interactions sheet they provide.

Better Pharmacies do, however try to discuss the drug with you.

I'm not sure on any actual law, but they definitely filled the prescription wrong, which should be reported to your state's licensing department.

it depends on insurance and how to prescription was written. Insurance will try to get the pharmacy to sub for a generic, unless the doctor specifically writes the prescription for the name brand, and notes to make no subs.

The pharmacy doesn't need to tell you, because it is the "same" drug, and it is usually noted in your insurance policy that subs can and will be made if a generic option is available.

lyacovett said:

it depends on insurance and how to prescription was written. Insurance will try to get the pharmacy to sub for a generic, unless the doctor specifically writes the prescription for the name brand, and notes to make no subs.

The pharmacy doesn't need to tell you, because it is the "same" drug, and it is usually noted in your insurance policy that subs can and will be made if a generic option is available.

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It's not the same drug if one could kill her and the other can't.

I think they made several mistakes, but the simplest thing to do is go back and tell them.

Its not uncommon to get different brands of generic drugs as long as the script is for the proper dosage . But they screwed up as there should be a notation on your wifes file that she can't have gluten . Take it back and set them straight .

Now if the script said "dispense as written" for say Lipitor and you get something else thats another matter

lyacovett said:

it depends on insurance and how to prescription was written. Insurance will try to get the pharmacy to sub for a generic, unless the doctor specifically writes the prescription for the name brand, and notes to make no subs.

The pharmacy doesn't need to tell you, because it is the "same" drug, and it is usually noted in your insurance policy that subs can and will be made if a generic option is available.

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Every time by insurance company wanted to CHANGE my current perscription they notified me in writing and requested I send that request to my doctor to change my perscription.

That said I think you are right, unless the doctor gives them permission to substitute they cannot. I have seen my doctor in the past write no substitutions on the script.

when my doctor has written the script to be filled as specified, my insurance was quick to require pre-authorization and a written explanation of "why" THAT drug must be dispensed. The pharmacy has always notified that there is a sub that insurance won't question.

It's nice to know my insurance is looking out for my best interests, unlike my doctor.

jgln if the drug is brand name one yes the Dr. would have to write a new script for the one the Insurance wants you to use. But in this case it was generic to generic . 10 mg of morphine whomever makes it is the same and if your Dr just wrote morphine and not Roxanol they can give what ever generic they have.


I am not concerned about the generic switch its just the pharmacy should have caught the Gluten Free notation.

Maybe go back to the pharmacy and make nice with the pharmacist?

I don't know how much stress pharmacists are under so I couldn't even guess the number of mistakes that get made. If you just talk to the guy and explain why its so important that this mistake not be made again in the future, then I'm sure he'd be more than happy to make it right. And if you made a new friend out of the ordeal, then that would be a good reference for future problems that arise. It certainly couldn't hurt.

Not to question it, but are you 100% sure it's not gluten free? Most pharmaceutical drugs are, so if it isn't, I'm surprised. My wife is also a celiac and recently had her first baby. Be careful with those prenatal vitamins for someone with celiac disease... most contain a stool softener... not the best thing for someone with celiac disease.

Pharmacies are getting ridiculous; especially the mail-order ones run by the insurance companies. I came home to find the wife in tears one day - they had subbed a medicine she *knows* doesn't work on a clearly DAW scrip. I got on the phone with the asshat and told him to pull up the prescription as we keep copies before sending them in. Does it say Dispense As Written? "Yup," he said, "but we called the doc and he OK'd the change." Really? That's strange as he's been out of the country for several weeks. I told the chap to shut up and listen. His company had violated federal and state law. He had 24 hours to make it right or I would be getting very rich from suing them and said pharmacy would very likely be barred from filling in the state of CO.

They had the correct med in the Mrs. hand by 10am the next morning.

Raise hell and take no **** from them. They're raping your paycheck anyway.

Wow. i work in the pharmaceutical industry and tell you that the pharmacist has to call the doctor on that one. insurance companies clearly push for generics as much as they can. When a doctor writes, "medically necessary" on a script, the pharmacist knows to call the doctor.

we are all human though, so it could have been by error. it looks as if it was resolved. unfortunately you wont prove that your doctor wasnt contacted by the pharmacist, even though he/she was out of the country. doctors always have their cell phones and also have a staff. even if they have a nurse practitioner or a covering doc, that person can make the change for your pharmacist.

prenatals have been around for a long time now, so obtaining a branded prenatal is getting tougher and tougher on all ends. when a drug becomes generic, only one company can distribute the generics for the first 6 months, then multiple generic firms can distribute. sometimes, this causes an issue as the drugs can look differently between one generic company and another. the only issue is if the generic you got truly wasn't gluten free. then the error was in the pharmacists hands, or possibly the doctors if he/she approved the switch without recalling your need for a gluten free prenatal.


to answer your question. it is not illegal for a pharmacist to switch out a drug, but it has to be done appropriately. part B of your question states that the pharmacist checked off on a drug that was not what you call in for. It 99.9% likely was the same drug (by chemical compound), but not by physical appearance. The active ingredient is the same, but the non-active ingredients were different. this is the problem with generic companies and FDA regulations, because the same drug made by different companies could be different.

BucksPA said:

unfortunately you wont prove that your doctor wasnt contacted by the pharmacist, even though he/she was out of the country. doctors always have their cell phones and also have a staff. even if they have a nurse practitioner or a covering doc, that person can make the change for your pharmacist.

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Won't fly in court. That's called hearsay. Besides, I've never known a doctor that would even think of changing a prescription w/o telling the patient.

Oh, and FWIW, the Mrs. has subsequently seen the doc. He authorized no changes.

jkarp said:

Won't fly in court. That's called hearsay. Besides, I've never known a doctor that would even think of changing a prescription w/o telling the patient.

Oh, and FWIW, the Mrs. has subsequently seen the doc. He authorized no changes.

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it happens all day every day. doctors always change scripts. the pharmacist should then inform the patient when they pick it up. however, we are all human and people make mistakes.

now, you say the doctor authorized no such changes so then the problem falls into the pharmacists hands. the pharmacist will push it to the insurance company and their 100,000 person legal team will easily push this matter aside.

Go talk to the pharmacy and make them aware that she is a celiac. The rph can sub like for like and may not know about her gluten intolerance. We all make mistakes. This may have been a mfg change from the chains warehouse or they may have been trying to save you money or trying to save you the trouble of coming back. Bottom line go back and talk to them