Sheila A. Robinson, M.D.
Dr. Robinson is President of the Georgia State Medical Association

More Georgia doctors are finding their ability to care for their patients negatively impacted by third parties. This news comes as the Georgia State Medical Association (GSMA) has released survey results detailing a trend affecting patients in Georgia.

The survey, conducted with 100 physicians across the state of Georgia, lays blame on a practice known as cost-based therapeutic substitution.  This practice occurs when someone other than a patient’s doctor switches a patient’s medicine based primarily on cost. All 100 of the surveyed physicians believe that patient health – and not cutting costs – should be the first consideration when prescribing medicine.

Cost-based therapeutic substitution is another illustration of the erosion of the doctor-patient relationship which undermines the ability of the physician to act in the best interest of the patient.  To interfere with this relationship without the explicit approval of the physician may compromise the health and well being of the patient.  Physicians, because of their global knowledge of the disease process in a particular patient, are the only individuals who are in a position to assess the potential negative consequences of drug substitution. 

The simple fact is this:  Drug substitution without the knowledge and approval of the caregiver places the patient in potentially major danger. It can sometimes lead to a patient receiving less effective medical treatment, often without their full knowledge. The physicians surveyed were unanimous in their belief that it can be dangerous for patients to have their prescriptions switched if their physician is not informed of the change. While most physicians are open to speaking with a pharmacist about a potential change in treatment, third parties are too often bypassing this important step.

Therapeutic substitution means a patient is given a different medication in the same broad “therapeutic class,” even though drugs in the same class often work in different ways and have important differences in side effects and effectiveness for individuals.  This substitution may pose serious risks to the health and safety of patients taking certain prescribed medication and jeopardizes appropriate medication decisions made between a patient and his/her doctor.

One of the most important aspects of the care a physician gives a patient is the ability to choose the pharmacologic agent necessary for the management of their disease or condition. When insurance companies and pharmacists are allowed to make this decision, a core principle of health care is eroded.

Physicians should be able to prescribe the best care for their patients without this outside, third party influence.

Cost-based therapeutic switching poses a vital risk to patient safety in the state of Georgia, and it needs to be addressed immediately. The GSMA urges state legislators to pass legislation to preserve the rights of the physician to make prescription decisions for their patients without the outside influence of third parties.