Epilepsy Talk

Prescription Switching. Do You Know What You’re REALLY Getting? | August 14, 2017

How many times have you had a prescription switched without your knowledge or permission?

Not just switched to a generic version of the prescribed drug, but to a different drug altogether.

Yet the practice of swapping out medications is perfectly legal in most states.

It’s called “therapeutic substitution” and it happens when a patient is switched from to a cheaper medication in the same class of drugs.

With therapeutic substitution, a pharmacist substitutes a chemically different drug for the drug that the physician actually prescribed.

The drug substituted by the pharmacist belongs to the same pharmacologic class or to the same therapeutic class.

However, since the two drugs have different chemical structures, there are potentially adverse outcomes for the patient. (Sometimes you can even tell by the shape or color of the pill!)

The move may be from a name brand to a generic, but it also can be to a different medication entirely.

And why are the pharmacies switching you?

To save money, of course.

But then there are the insurance companies — putting pressure not only on the pharmacies but on doctors, too.

“Pharmacies are directly reimbursed by insurance companies and make more money from generics even though the sticker price for brand-name drugs is higher,” says Dr. Robert Reneker, an urgent care physician.

“I’ve had pharmacies tell me a drug isn’t on the formulary when I’ve already checked with the insurance company and know that it is. The switch to a cheaper substitute is motivated purely by profit.”

The one benefit for you may be smaller co-pays.

But two-thirds of people who reported having meds switched in a National Consumers League survey said they weren’t consulted.

Of those, 40 percent said the new drug was not as effective, and a third said it had more side-effects.

“It’s not okay for your insurance company or pharmacist to change your drugs without your knowledge,” says NCL Executive Director Sally Greenberg.

But, unfortunately, therapeutic substitution is likely here to stay — meaning you need to be on the lookout to make sure you’re not harmed by the practice.

Some suggestions:

Ask your doctor to write “DAW” on the prescription, which stands for Dispense As Written.

Have your pharmacist put a note in your records that says you don’t want any prescription switched without your approval.

If you’ve noticed the pharmacy has switched your medication anyway, get your doctor’s office on the phone to explain why you need the specific drug that was prescribed.

If your prescription HAS been switched, you should ask your pharmacist these questions:

Is this the exact drug my doctor prescribed?

Will this switch affect my health?

Why are you switching my prescription?

Have you notified my doctor of this switch?

Will the new drug work better?

How will I know if it does or doesn’t?

Are side-effects different from those associated with the original prescription?

How will it interact with other medications or supplements I might be taking?

An Epilepsy Action survey showed that of those given alternative versions of their usual anti-epileptic drugs in one year, almost a quarter (23 per cent) said their epilepsy got worse. Most of these people reported an increase in the number of seizures they had.

Almost half (43 per cent) of those who spoke to their pharmacist were told that there was nothing to worry about and that all versions were the same. One in seven (15 per cent) found that pharmacists were not aware of the issue.

In its survey, Epilepsy Action asked people whether they spoke to their doctor after having been given a different version of their AED. Almost a third (31 per cent) were told there was nothing to worry about. Nearly a quarter (22 per cent) were told all brands were the same and one in six (16 per cent) found their doctor was not aware of the issue.

One good piece of news. Restricting substitution of epilepsy brand-name drugs has been filed in eight states. (Connecticut, Georgia, Iowa, Massachusetts, Michigan, Minnesota, New Jersey and New York). Let’s hope more states follow their directive.

NOTE: This letter has been created by the Epilepsy Foundation to make explicitly sure that no substitutions are made to your prescription without full consent by you and your doctor. You might want to make a copy of it for your files.

Dear Pharmacist: 

Thank you for providing me with the valuable service of filling my needed prescriptions. The purpose of this letter is to let you know that I have epilepsy and it is vital that I receive the same medication from the same manufacturer monthly in order to maintain the expected level of seizure control and side-effects.

Please ensure that no changes are made to my medications, including a change in manufacturer, without prior consent from my physician and myself. Please note this request in my file. To assist you, I have listed below the name, manufacturer, and dosage of the medications I am currently taking.

Thank you very much,

Your Signature________________________________________

Today’s Date__________________________________________

Your Printed Name_____________________________________

Phone Number________________________________________

Physician’s Name______________________________________

Phone Number________________________________________

Brand Name__________________________________________

Generic Name_________________________________________

Manufacturer _________________________________________

Dosage ______________________________________________

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  1. Thanks for the eye-opener Phylis.

    Here’s my Canada-France reality. I take Dilantin (slow-release phenytoin).

    It’s not available in France so the French neurologist prescribes Di-Hydan. Then there’s a shortage of Di-Hydan and I’m prescribed Diphantoine. Luckily I planned ahead and have plenty of Dilantin. So I don’t switch.

    Despite my questioning it was never made clear what the differences are. It was also disturbing that I was much more well informed than disinterested pharmacists (in Canada and France).

    Back in Canada my neurologist, to his credit,admitted he had never heard of Di-Hydan and was surprised Dilantin wasn’t available in France.

    Now I could possibly switch and suffer no side-effects. Or I might…

    Should I risk it to serve the politics of the pharmaceutical industry?

    Oh, I just noticed Di-Hydan is out of stock in France again: https://www.vidal.fr/Medicament/diphantoine-141643.htm

    I guess that says it all.


    Comment by philamisan — August 14, 2017 @ 12:22 PM

    • Your health is far more important than “the politics of the pharmacy industry.”

      (So much for France. I just don’t get it. If Canada can get the med, why not France?)


      Comment by Phylis Feiner Johnson — August 14, 2017 @ 1:31 PM

  2. This is another reason I always request BRAND NAME drugs, no matter WHAT the drug is taken for. Just about 100% of all generic names for ANY neurological drug, will have forms of ASPARTAME or MSG in it, and 50% of them will have forms of both in the drugs sold by generic names.Generic name drugs used for AED’s by most people to save MONEY is good, but at What CO$T after you’re taking them? It would be a CLEAR SIGNAL when you may be seizure free with a BRAND NAME drug, then like a 180 reverse of more seizures should send WARNINGS that not always your condition is getting worse, but maybe the drugs changed & the chemicals you are taking are MSG’s & ASPARTAME’s that were never in any BRAND NAMES. << That is changing sadly where a few NEWER & RECENT brand names are not much different from generic name drugs for AED's, Anyone who lives in West Virginia should know this, that the STATE limits what the drug stores sells to people who needs drugs, They limit & allow drug stores only to sell GENERIC NAME drugs. A request from any doctor is required for the drug stores to sell and fill a BRAND NAME of any drug. The patient has to ask first their doctor for that BRAND name to be filled.


    Comment by C D — August 14, 2017 @ 1:19 PM

  3. I live in SC and this is common practice. I find that the fillers vary from manufacturer to manufacturer. Many times the fillers being used will cause seizures. Anyway I found one particular drug and one specific manufacturer I can tolerate in very low dose. I have to specify over the phone exactly what I want or the pharmacist will substitute despite it being on record. I even have to recheck and look at the medication to be sure…I have made many changes in my life and also use CBD which has made big difference. If I slip up on my diet then I am prone to have seizures. My story is long but I thank God daily for another great day.


    Comment by deborah harley — August 14, 2017 @ 4:46 PM

    • It sounds like you’re being diligent and that’s the most you can do. Correct others or suffer the consequences.

      It’s unfortunate that we have to do this but…


      Comment by Phylis Feiner Johnson — August 14, 2017 @ 4:52 PM

  4. I have a certain gernice I want so my doctor write dispense as written there fore I also get that type.


    Comment by Pauline Polzin — August 14, 2017 @ 4:56 PM

  5. Pls read you both. Be aware of substitution without your knowledge etc.


    Comment by Priscila — August 15, 2017 @ 1:33 AM

  6. While coping with Epilepsy remains a very complicated everyday ordeal, surviving the medical establishments & “health care” industry crusading for profit makes Epilepsy more complicated than it needs to be.
    Thanks for sharing your experience, many Epilepsy patients has come to learn that there’s more to Epilepsy than just the obvious seizures.
    Standing up to corrupt medical establishments taking advantage & exploiting the victims of Epilepsy, while being knocked down & out by uncontrolled seizures, has got to be a very heavy cross to carry around.


    Comment by Gerrie — August 15, 2017 @ 12:26 PM

  7. You have to pay attention for your medications. I do not trust any longer Doctors, Lawyers, Pharmacies and even our Goverment as I used too . We do have many problems and more to come. Good luck to the young generation.


    Comment by Dimitris Marantidis — August 15, 2017 @ 8:19 PM

  8. so many insurance companies will only cover generic drugs. So what do you do if you are prescribed a brand name medication – let’s imagine it’s $500.00, and insurance does not cover it…………….?

    I also had to have blood tests today for medications. I happened to ask my Dr. about the Keppra and told her the side effects I had been having. I have heard of even doctors that take Keppra. One told me they do not get any side effects…………..and she didn’t sound like she agreed to find something different, but did decrease the dosage. Time will tell- like usual, I’ll not notice any change with refractory.


    Comment by Karen — August 16, 2017 @ 12:16 AM

  9. I’m speaking for the company I work for, I am not a pharmacist, I am a nationally certified technician. A drug sub is not allowed to be done without the doctors permission AND patients get mandatory counseling for all new drugs. If a particular drug is unavailable or not covered by the insurance we contact the doctors office and the doctor determines whether or not the drug will be changed or the process of a prior authorization will be completed nothing is changed without their say so. Even when the insurance is asking for a particular drug within the same class the pharmacist can not make the change without the doctors permission. A patient would never walk away not knowing something has changed, whether it’s the drug itself or a change in the manufacturer, at least not from us. Some companies allow the patient to refuse counseling while picking up but I’m sure at the very least they are told something has changed.


    Comment by Ana — August 17, 2017 @ 10:32 AM

  10. Well Phylis, Thanks for another eye opening column. I had no idea anything like this was going on. I had heard of pharmacies changing generic manufacturers. But for a pharmacy to just take it upon themselves to change to a similar drug? We might as well do away with health care & doctors all together, and get each pharmacist a nice fresh, new set of chicken bones to throw in the air and read, then he can tell us everything we should need for a better more prosperous life. Who needs a healthcare system.


    Comment by Edbrad — August 17, 2017 @ 7:52 PM

    • I love “throwing the chicken bones in the air” for a better more prosperous life!

      As for a healthcare system, I’m not sure the answer is there, with BIG Pharma’s lobby buying up all the politicians.

      In fact, I’m not sure what the answer is. 😦


      Comment by Phylis Feiner Johnson — August 17, 2017 @ 8:24 PM

  11. . I come not cartel any longer Doctors, Lawyers, Pharmacies and even our Goverment as I used too .


    Comment by arsenios — September 12, 2017 @ 6:48 AM

  12. Love it!
    I was pregnant with my first and on bed rest! I worked in a big university hospital where a got my Brand name of Tegretol! My Neurologist said go to a pharmacy nearby. It was generic. I was 6 months pregnant and had a seizure from the change of medication. I had no idea. This was in 1992. I woke up in the Emergency room. Telling them to use a Doppler to get my nannies heart rate. They kept me all day. I had another one. I was given medication from the hospital before leaving.


    Comment by red2robi — November 10, 2017 @ 10:06 AM

    • What a nightmare!

      You know that generics have just 80% of the original formulary and then 20% of unknown “filler”. That’s what will get you every time! 😦


      Comment by Phylis Feiner Johnson — November 10, 2017 @ 10:27 AM

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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

    View Full Profile →

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