Therapeutic substitutes

Behavioral and environmental modifications may significantly improve dry eye, especially in mild cases. Evaluate the patient s environment for air drafts. Consider adding a humidifier in low-humidity areas. Schedule regular breaks from computer work or reading. Lower the computer screen to below eye level to decrease lid aperture. Evaluate medication use and make therapeutic substitutions to medications that do not exacerbate dry eye. Spectacle sideshields or goggles may reduce tear evaporation.30... 

Some empirical observations are significant in this respect. For example, the demand for brand products is fairly sensitive to the price of generics, and even in some cases to the price of brand name therapeutic substitutes. In an estimate of the parameters of the demand function of brand products and generics in the cephalosporin submarket in the USA, a high price elasticity was observed between brand products and generics, and also in some cases, although to a lesser extent, between therapeutic substitutes.4... 

PCR should be removed from all products that are subject to competition, whether they be generics or therapeutic substitutes for which reasonable elasticity can be expected. 

The objective of this chapter is to analyse the extent to which pharmaceuticals withstand competition from therapeutic substitutes and generics in the UK and Spain. Our hypothesis is that substitute drugs compete in markets, but that the type of competition they face depends on the specific regulations in force in each of the countries studied with regard to entry, price and prescription. 

The market share of the most frequently prescribed active ingredient is very small both in England and in Spain, and the prescription concentration at the level of therapeutic substances is also very low. These data paint a picture of fierce competition in markets of drugs containing different active ingredients. However, we need to study the market structure and therapeutic competition at a lower level of therapeutic aggregation in order to be able to evaluate the extent to which pharmaceuticals enjoy dominant positions in their respective groups of therapeutic substitutes. 

The sample involves a regression analysis framework that estimates the effect on price of the number of generic products of the same molecules. Danzon and Chao (2000) also control for the number of therapeutic substitutes, hrst-mover advantages, molecule age, and several other factors. 

Laliberte, Richard. The Great Drug Switcheroo Therapeutic Substitution. Prevention 61, no. 5 (May 2009) 117-121. In some cases, pharmacists can fill prescriptions with other drugs that are similar or identical without the doctor or patient knowing. This article describes some cases in which the substitution drug caused problems. The substitution aims to reduce costs, but more care is needed to make sure that treatment is not compromised. 

Sustains the formulary by minimizing nonformulary procurements, utilizing therapeutic substitution protocols, and promoting rational drug therapy selection. 

In contrast to open formularies, closed formularies are strictly controlled. Only certain agents are available and strict therapeutic substitution with the most recognized agent within a pharmacological class is standard procedure. The purpose of this type of formulary is to assure availability of all needed products at the least cost of inventory investment. Because this mechanism of control maintains the least costly of products, it is ostensibly the most cost effective. However, significant restrictions on medication use often produce dissatisfaction and dissension among the health care practitioners and patients. Further, Horn et al. (1996) suggest that strictly controlled formularies may increase overall health care costs. 

Therapeutic substitution, where a drug of different chemical structure is substituted for the drug prescribed by the doctor. The substitute is of the same chemical class and is deemed to have similar pharmacological properties and to give similar therapeutic benefit. Therapeutic substitution is a particularly controversial matter where it is done without consulting the prescribe and legal issues may be raised in the event of adverse therapeutic outcome. 

The first description of zinc deficiency in a patient with alcoholic cirrhosis (B.L. Vallee etaf, 1956) has meanwhile been confirmed by numerous investigations. In cases where zincuria is initially elevated and subsequently reduced, the decreased zinc levels may be used for diagnosis and at the same time indicate therapeutic substitution. 

Good CB, Fultz SL, TriUi L, Etchason J. Therapeutic substitution of cimetidine for nizatidine was not associated with an increase in healthcare utilization. Am J Manag Care 2000 6(10) 1141-6. 

Under the proposed legislation, pharmacists would be allowed to substitute prescribed products only with a bioequivalent generic therapeutic substitution would not be permitted. Doctors could prevent substitution by marking the script accordingly. Approximately 50 percent of products are not reimbursed. This includes nearly all OTCs, but also minor tranquilizers, some anabolics and amphetamines. 

Another regulatory issue is therapeutic interchange of medications. PBM clinical departments often set up internal protocols for alternate product substitution within a therapeutic class. The National Association of Boards of Pharmacy contends that therapeutic substitution is practicing pharmacy. In one of its position papers, the Academy of Managed Care Pharmacy supports the use of therapeutic interchange programs. The Academy of Managed Care Pharmacy contends that this decision is ultimately that of the physician. 

Therapeutic Substitution The act of dispensing a therapeutic alternative for the drug product prescribed without prior authorization of the physician. This is a controversial procedure. 

Managed Care Pharmacy Factsheet-Therapeutic Substitution Academy of Managed Caro Pharmacy Alexandria, Virginia, 1997. 

Abood, R.R. Legal issues confronting the therapeutic substitution of drug products. Clin. Trends Pharm. Practice 1995, 9, 1-11. 

American College of Physicians. Therapeutic substitution and formulary systems. Ann. Intern. Med. 1990, 113 (2), 160-163. 

W. A. Thames, S. L. Smith, A. C. Scheifele, B. Yao, S. A. Giffin, and J. L. Alley, Evaluation of the US Oncology Network s recommended guidelines for therapeutic substitution with darbepoetin alfa 200 meg every 2 weeks in both naive patients and patients switched from epoetin alfa. Pharmacotherapy 24 313-323 (2004). 

Substitute therapies (drugs) Use of another drug similar to that prescribed in order to achieve the same clinical benefit. Drug substitutes can be therapeutic substitutions (drugs are not identical but produce an identical effect)... 

The term pharmaceutical alternative is used to define the medicinal product with the same active ingredient, although the dosage form, salt form or strength may vary, such as substitution from a tablet with immediate release to controlled-release, or from capsule to oral solution. Therapeutic substitution is the mutual substitution of medicinal products with different active ingredients, both of which may or may not belong to the same therapeutic group. 

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