The antisubstitution controversy: Going strong in '72

In 1972, three years after the American Pharmaceutical Association (APhA) called for a resolution to repeal all state laws prohibiting the substitution of one prescription drug for another, the controversy continued to rage, pitting pharmacist against pharmacist, according to that year’s April 10 edition of Drug Topics.

See also: "Bitter ender" holds out against corporate pharmacy

A number of other pharmacy organizations opposed drug substitution by the pharmacist, including the American College of Apothecaries, the National Association of Boards of Pharmacy, the National Association of Retail Druggists, the National Association of Chain Drug Stores, and the American Medical Association.

With generic substitution widely accepted today by patients, healthcare providers, and pharmacists, it’s hard to believe that this once was such a contentious issue. According to the report “Generic Drug Savings in the U.S.,” published last year by the Generics Pharmaceutical Association, approximately 3.8 billion prescriptions dispensed in the United States in 2014 - or 88% of all prescriptions dispensed - were generic medications.

However, change takes time. Pharmacists quoted in 1972 listed a number of reasons for opposing substitution.

See also: Physician dispensing: Convenience does not always equal benefit

The doctor knows best

“The doctor is the one in contact with the patient, and he knows the tolerances of that patient and his acceptance of some drugs and his body’s rejection of others,” said E.J. Scheidt, manager and chief pharmacist of Brandenberger Drug Co., Jefferson City, Mo.

Pharmacist’s duty to follow the prescription

“I am positively against any form of substitution. If a doctor writes a generic product on the prescription, that’s different, but it is the duty of the pharmacist, above all things, to see that the patient gets what the doctor wants him to have, no more, no less, and no different,” said J.A. Buente, RPh, The Buente Bros. Drug Co., Warrensburg, Mo.

Fear of inferior drugs

“There has to be an antisubstitution law, because I’ve seen too many cases where inferior drugs were substituted. Smaller manufacturers may not have strict enough quality control, and some drugstores are too price-conscious,” said Ralph A. Jensen, P&S Pharmacy, San Mateo, Calif.

Another pharmacist from Springfield, Mo., said, “I do have my favorite brands, and in my mind these brands represent the highest quality that can be produced.”

Not everyone favored the status quo. One pharmacist said he agreed with APhA because “the doctor is usually busy and hard to locate, so it may take half a day to get him on the phone and get permission to substitute [one drug for another].”