Most of us rightly rely on our doctors to answer our health questions and provide us with quality care. They know our medical history and they are able to take many different issues into consideration when choosing the best course of treatment. Sadly, less and less value is placed on the doctor's decision and more emphasis is placed on cost rather than "what is the best course of treatment for my patient?"
Unfortunately, this is happening all too often in some pharmacies. While you may be stable on a medicine you have taken for 20 years, there is a chance that the next time you pick up your refill, you might get a different prescription medicine. Across Alabama, this type of "switching" of medicines is happening — without prior approval, or even knowledge — by the physician. It is a scary practice and should alarm all of us.
The encouragement to switch is usually based on cost and perhaps without regard for what is best for the individual patient. Taking a patient off of one medicine that is working well for them and switching them to another is known in the health-care community as inappropriate "therapeutic substitution."
Switching is not done for medical reasons but primarily because of cost or the belief that all medicines within a specific class of drugs are the same. We all know that is not the case because many of us have changed our medicines to accommodate for different side effects or interactions with other medicines we take.
In most cases, generic substitutions are fine. The substitute works just as well and saves money. The therapeutic substitution (or outright switch to some other drug) may be more of a problem in terms of effectiveness or side effects.
In either case, if the switch is made because there's a hidden financial incentive, and not because it is in the best interest of the patient, that needs to be stopped. At the very least, patients ought to know about it and be able to talk about it with their physician.
If a switch generates cost savings for anyone other than the patient, patients ought to know who benefits and to what extent. Full disclosure should be made in plain language that's easy to understand.
Cost-driven switching can hurt all patients. It erodes the doctor-patient relationship, puts profits over patient health, ignores the differences between medicines and creates confusion for the patient.
If you are a senior and this has happened to you, ask your doctor or pharmacist. You may not be getting a generic equivalent, you may be getting a different medicine altogether. If something looks different when you pick up your medicine, ask questions. Your health is not worth the risk.
Dixie Kuykendall is president Alabama Advocates for Quality Care in Mt. Olive.
