What is therapeutic substitution? It is the practice whereby the drug prescribed for you is not dispensed as written, or even as the generic of what was specified. Rather, the drug dispensed is a generic for the CLASS of drugs to which the specified drug belongs.
Thus, if your prescription says Crestor®, you could get a generic for Lipitor®. Please note that Crestor and Lipitor are not the same compound, and do not have the same efficacy, although they are both statins. Individual patient reaction—for both the indication and side effects—of these two drugs is often different.
Yet, therapeutic substitution is exactly what Pfizer, the manufacturers of Lipitor, is hoping for. After all, generic Lipitor will be introduced after November 30, 2011, and Pfizer would like nothing better than to drive down the market share of the remaining branded statins. As an added bonus, Pfizer will probably be coming out with its own generic version of Lipitor, as well.
My latest HND piece examines the encroaching phenomenon of therapeutic substitution, and lists a few drugs for which this practice has already been occurring. Bear in mind that the volume usage of those drugs does not even come close to statins. Indeed, Lipitor all by itself is the biggest selling (legal) drug of all time, and it is just one of several statins.
There is considerable pressure to institute therapeutic substitution on a much wider scale. The fear is that if the single biggest class of drugs goes this way, no one will be able to put the therapeutic substitution genie back into the bottle.
But, who cares about patient outcomes if “the system” can save a little money, right?
Read the complete article. (Shaw’s Eco-Logic)