National Consumers League


NCL Health Issues

Benefits and risks of therapeutic substitution

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Therapeutic substitution can be a good thing, but it also poses some risks. The key to making the right decision for you regarding a potential switch is having open lines of communication between patients, doctors, and health insurance plans. It’s important to understand the reason for a switch, and the possible downsides, to make a smart decision.


When a Switch Might Benefit You

Could save you money. If your current drug is no longer covered, switching to a new drug that is just as safe and effective and is covered could save you a lot of out-of-pocket expense.

Could be more convenient. Sometimes a new drug will be different from the old in positive ways – it might be more effective, or you might have to take it less often.

Could save your insurance company more money. It might not matter as much to you, but as long as your doctor thinks the drug is safe and as effective, why not switch to a cheaper overall drug?

When You Might Be at Risk

The switch could be dangerous. The new drug might not work as well as the first, or it might work differently. It could have new side effects, or it could interact badly with food, other prescription or OTC medications, or dietary supplements.

Could be less convenient. Besides more potentially serious problems (like side effects, interactions, or reduced effectiveness) the new medicine could have a dosing schedule that is less convenient than the original.

Weighing the risks and benefits is crucial to deciding whether the switch is a good option for you. This is why it’s so important that:
Your doctor is aware of the switch and all other drugs you’re taking and
Your health should be the most important factor in determining whether a switch is right for you.

Look out for Number One.
If you’re like most consumers, it’s important to you to be involved in your health care decisions. In a recent survey conducted for NCL, nearly ¾ of Americans said they’d be very concerned if substitution happened without their consent or their doctor’s. This is not usually how substitution happens, but you should be aware of any changes to your prescriptions and always talk to your doctor if you think something has changed.

Keep track of your medication and know what you are taking.
This will make it easier to know if your medication is being substituted for another medication even if you aren’t informed in advance. It also helps you be a good patient all-around – it’s up to you to keep track of your medications and conditions. When you’re at the doctor, and he gives you a prescription for the first time, write it down.

Talk to Your Doc!
If you are contacted by your insurance company about a switch, it is important to talk to your doctor. Just as you want to be informed about these things, so should she. You might get a letter from the insurance plan encouraging you to consider therapeutic substitution, saying you can save money with a different drug. Or maybe your current drug is no longer covered. Remember, your doctor knows best. Show him the letter and sit down for a conversation.

If your insurance company (or your doctor) wants you to make a switch, ask your doctor “Why?” Also ask:

  • Will the new medicine work better? How will I know whether it’s working better or worse?
  • Will it lower my costs?
  • Should I expect different side effects?
  • Are there possible interactions with other medicines, dietary supplements, or foods?
  • Will I need to do anything differently with this medication?
  • What signs of trouble should I watch out for?
  • What if I want to switch back?

“But I don’t wanna switch!”
If your doctor thinks that your current medication is best, but the insurance company is pushing for a switch to a drug that is covered, you may be able to appeal to your health plan to continue coverage. Call your health plan for information about how to appeal.