Where We Stand On...

The Academy of Managed Care Pharmacy (AMCP) supports the use of therapeutic interchange programs as a part of a comprehensive approach to quality, cost-effective patient care.

Therapeutic interchange is the practice of replacing, with the prescribing physician's approval, a prescription drug originally prescribed for a patient with a prescription drug that is its therapeutic equivalent. Two or more drugs are considered therapeutically equivalent if they can be expected to produce similar levels of clinical effectiveness and sound medical outcomes in patients.

Therapeutic interchange programs are used in health care delivery systems that coordinate the prescription drugs patients receive to optimize patient care. These systems often use formularies which list preferred drugs as a prescribing guide for physicians in cases where alternative drug products are available to treat a particular patient's condition. Therapeutic interchange programs and formularies are commonly used by hospitals, health plans, and pharmacy networks administered by health plans or pharmacy benefit management companies (PBMs).

Therapeutic interchange programs are guided by evidence-based prescribing guidelines. These programs are developed and administered by a team of physicians, pharmacists, and other medical practitioners who are experts in the diagnosis and treatment of disease. The programs are designed to work in conjunction with other tools that health care professionals use to promote quality medical results.

• Value to Patients: When therapeutic interchange occurs, physicians and other health care experts have determined that patients will experience similar or improved clinical outcomes with the replacement drug. The replacement drug may be more convenient for the patient to take. For example, a patient is more likely to take all of the drug prescribed if he or she is moved to a therapeutically equivalent product that only needs to be taken twice a day rather than four times a day. A product that causes side effects may be replaced with one that does not. A new drug that offers improved therapeutic outcomes may replace an older remedy. A patient is generally less likely to miss doses, and thereby gets the full clinical benefit of their prescription, if the drug is convenient to use, causes fewer side effects, or provides improved control or relief of their condition.
• Affordability: A replacement drug that is therapeutically equivalent might simply cost less. Once two drugs are determined to result in the same positive outcomes for the patient, it makes sense for the hospital, health plan, or pharmacy network to use the less expensive alternative.

Therapeutic interchange, however, is not always about lower drug costs. Therapeutic interchange often occurs when overall health care savings can be achieved. Replacing one drug with a more expensive one may result in fewer treatment failures, better patient adherence to the treatment plan, and fewer side effects. Such efficient use of medical resources helps keep medical costs down, improves the patient's access to more affordable health care, and enhances the patient's quality of life.

Revised by the AMCP Board of Directors, February 2003

Approved by the AMCP Board of Directors, November 1999