New survey reveals consumers wary of prescription switches – National Consumers League

October 1, 2008

Contact: 202-835-3323,

WASHINGTON, DC — According to a new survey released by the National Consumers League

(NCL) today, nearly three-quarters of prescription drug users would be very concerned if a drug they were prescribed was switched to another drug designed to treat the same condition without their doctor’s knowledge. Even with their doctor’s knowledge, one in five surveyed are concerned about the practice, known as therapeutic substitution, the dispensing of an alternative to a prescribed medication that is not chemically or generically equivalent but is in the same therapeutic class and is used to treat the same condition.

“Consumers are justifiably concerned about the practice of therapeutic substitution, how it’s done, and who’s involved,” said Sally Greenberg, National Consumers League (NCL) Executive Director. “For some conditions and treatments, it may make good financial or medical sense to swap out one prescription for another. But, as consumers reported in our survey, it’s essential for them to be a part of this process, to know their doctor is aware and supportive of the switch, and to feel confident that their health and treatment – not financial incentives – are top priority.”

In an era of skyrocketing health care costs, insurance companies may turn to the practice of substituting similar (but chemically different), less-expensive drugs, from the same class.

Advocates are concerned primarily about the practice when it occurs without the patient’s knowledge, or without discussion and consent of their physician. However, opinions fall on either side of the debate, with physician groups expressing concern over patient safety, and pharmacist groups being more supportive of the practice as a cost-savings measure and a way to optimize patient care.  In some cases, the substitution can be beneficial or inconsequential, but in others – especially in treatment of epilepsy, mental health, and cardiovascular problems – it can be less effective or pose dangers, especially if done without the knowledge of the consumer or prescribing physician.

“Without transparency, therapeutic substitution could introduce efficacy or safety issues, including unknown drug interactions and potentially serious health consequences. It may evoke confusion or fear on the part of patients already feeling frustrated by a failing health care system,” said Greenberg.

The online survey of 1,387 adults aged 18 and older who have filled a prescription in the past year, which was conducted by Harris Interactive® for the NCL between August 25 and September 2 of this year, revealed that most consumers are not aware first-hand of therapeutic substitution, but they have objections and concerns about how and when a prescription drug should be swapped for another.

NCL released the survey today and announced a public education campaign to educate consumers about the practice of therapeutic substitution at its Web site, New resources help explain the practice and empower consumers to ask the questions necessary to feel comfortable and in control of their health care. For an executive summary and full copy of the survey, click here.  The survey also polled a sample of statin users to test the awareness of patients taking medications that might be impacted by therapeutic substitutions.  The views of this group largely mirrored those of the general population.

Survey Highlights

Consumers concerned about therapeutic substitutions that don’t involve doctor

  • Overall, prescription drug (Rx) users would be very concerned if a drug they were taking was switched to another drug in the same class without their doctor’s knowledge or consent.
  • Nearly three-quarters (70 percent) would be very or extremely concerned if their prescription or had been changed without their doctor’s knowledge and consent for a different medication meant to treat the same condition. And 77 percent strongly oppose the practice without the consent of the prescribing doctor or patient.

Consumers’ experiences with therapeutic substitution less than satisfactory

Of those who reported experiencing therapeutic substitution for themselves or a family member, 33 percent say that they (or their family member) did not have their doctor consulted before the substitution occurred, and two-thirds (66 percent) say that they/their family members were not consulted about the switch. Nearly half (47 percent) were dissatisfied (or their family was) with how the process occurred and report that this substitution did not result in lower pocket costs. Only a third (34 percent) felt that the substituted medication was just as effective as the original medication.

Consumers don’t know much about therapeutic substitution, but believe it happens frequently

  • 66 percent of Rx users surveyed have never heard of the practice of therapeutic substitution. 10 percent of Rx users report that they personally experienced therapeutic substitution of their medication in the past two years, and 9 percent said that a family member experienced it.
  • When respondents were given a description of therapeutic substitution (“replacing the prescribed drug with a chemically different drug (not just generic version of the branded prescribed drug)”), the vast majority of Rx users said they believe therapeutic substitution is occurring at least sometimes in the U.S. (84 percent), without informing the patient (68 percent) or the prescribing physician (59 percent).

Consumers are open to therapeutic substitution, but certain factors determine their comfort level

  • Rx users are most likely to consider switching to a different medication if their physician felt that the two were interchangeable (57 percent).
  • A letter from the insurer may not put consumers at ease, but it would evoke communication: only 19 percent of Rx users say they would consider switching to a different medication meant to treat the same disease if their insurance company sent a letter recommending this change, but receiving such a letter would inspire 71 percent of Rx users to have a conversation with their doctor about a less expensive alternative drug.
  • Nearly a third (31 percent) of Rx users say they would consider switching medications if their pharmacist called to discuss an alternative medication.
  • 68 percent of Rx users would oppose insurance companies offering incentives to physicians for switching patients to lower cost alternatives
  • 73 percent of Rx users would oppose insurance companies offering incentives to pharmacists to switch patients to lower cost alternatives

About the Survey

NCL commissioned this survey with an unrestricted educational grant from Pfizer.

This Consumers’ Views on Therapeutic Substitution Survey was conducted online within the United States by Harris Interactive on behalf of the National Consumers League between August 25 and September 2, 2008 among 1035 US prescription drug users aged 18 and older who have filled a prescription in the past year, and an oversample of 352 US statin users aged 18 and older who are currently on a statin medication. No estimates of theoretical sampling error can be calculated; a full methodology is available.

Complete survey results, fact sheets for consumers, and other resources are available at


About the National Consumers League
The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit

About Harris Interactive®

Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research, powered by our science and technology, we assist clients in achieving business results. Harris Interactive serves clients globally through our North American, European and Asian offices and a network of independent market research firms. For more information, please