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NAMI believes that all people with mental health conditions deserve access to effective medication and treatment options. NAMI supports public policies and laws that prohibit therapeutic substitution of psychiatric medications.
Mental health medications affect people in different ways, and individuals need to be able to access the medication that works best for them and their individual health needs. It is important that medication decisions are carefully considered with a health care provider who has both extensive knowledge of the individual and available medication options.
Sometimes, health insurers may request or require that a pharmacist substitute a person’s prescribed medication with a different medication that is expected to have the same effect. Therapeutic substitution occurs when the prescribed medication is switched to a chemically different drug. This is different from generic substitution, which means that the new medication has the same active ingredients as the prescribed medication. Therapeutic substitution is usually used to contain costs or because of drug shortages, and is often done without consulting a person’s medical provider or assessing their medical history.
For many mental health medications, therapeutic substitution can be a danger to the health of the person taking the medication, and undermines the decisions made between individuals and their health care providers. Instead, policies should include patient protections that maintain access to appropriate medications and require consent of the prescribing health care provider. Policies should specifically exclude psychiatric medications from therapeutic substitution provisions or allow the prescriber to exempt an individual’s prescription from therapeutic substitution by indicating as such on the prescription (by using terms such as “dispense as written” or “no substitutions”).
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