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Drugmakers and medical specialists oppose proposal to let pharmacists make therapeutic interchanges without physician approval
Summary
Pharmaceutical manufacturers and physician groups warned lawmakers that a board proposal to allow therapeutic interchange by pharmacists could risk patient safety and disrupt physician‑patient decision making.
Pharmaceutical industry and physician representatives warned a joint legislative panel that a Board of Pharmacy proposal to permit pharmacists to make therapeutic interchanges without prior physician authorization could risk patient safety and disrupt continuity of care.
Fred Notewear of the Pharmaceutical Research and Manufacturers of America said the board’s recommendation to change Business and Professions Code section 4052 to allow interchanges "without prior physician authorization" could lead to inappropriate substitutions across drug classes and endanger patients with complex medication regimens. "Patients also fill their prescriptions at more than one pharmacy. This means that a pharmacist may not have the full medication history...thereby making therapeutic interchange even more of a safety risk for patients," Notewear testified.
Randall Hager of the Psychiatric Physicians Alliance of California and a psychiatrist on his board said antidepressants and other psychiatric medications have distinct mechanisms, interactions and black‑box warnings, and that pharmacists cannot replicate the comprehensive clinical evaluation psychiatrists perform over multiple visits. "There is not simply enough patient contact, and there is not enough of the education and training necessary to make safe and effective decisions," Hager said.
The board did not adopt any statutory changes during the hearing. The issue remains on the committee's sunset review list for further consideration.
