I’ve ranted about how DAW-1s in the past, however a good chunk of “doctors” out there cant seem to understand exactly what it means when that “Do Not Substitute” box is checked. I use the word “doctors” in quotes because I am also referring to people who write prescriptions such as NP, PA’s and the extremely clueless Dentists and Certified Nurse Midwifes.
In California (and pretty much every state), pharmacist have the authority (which are few and far between, trust me) to switch from a brand name drug (Prilosec) to an FDA rated generic alternative (Omeprazole). We can do this all by ourselves! 7 years of college and a doctorate degree and doctors have trusted us with the power to switch the Brand to the Generic of a SINGLE DRUG without their all-knowing permission. I’m sure that when this law was snuck under the doctors nose they shit all over themselves! In fact, most pharmacists love it when doctors write the old brand name because I’d rather see “Adderall” than “Mixed Amphetaminescribblescribbledontknowwhatcomesnext”.
Now here is where the confusion comes in. That little box that says “Do Not Substitute”, that is to prevent us from switching from the BRAND name to the FDA approve generic FOR THAT DRUG. Idiots seem to think that we have the authority to switch from a Brand name to ANY GENERIC, we don’t. Unless you work for a hospital, have some P&T committee overseeing you, or have some collaborative practice agreement; pharmacists CANNOT switch to a completely different drug (even in the same class) without the doctors approval. We can just switch from the BRAND to the GENERIC of the SAME CHEMICAL. See how simple? Obviously not.
What blows my mind is when Dentists (*sigh*) check that box and write for Amoxicillin and Ibuprofen. So I read that the Dentist (*double sigh*) does not want me to auto-substitute a generic for… the… generic that he/she… uh.. just wrote for…. yeah. Certified Nurse Midwifes (uh, yeah, they can write for Rx’s and we cant, how’s that kick in the nuts towards our profession) LOVE to forbid me from substituting Docusate.. uh.. for docusate… hmm.. These people have prescriptive authorities? They don’t even understand what that damn little box means! “Oh, I don’t want this pharmacist substituting a generic alternative for this GENERIC THAT I’M GOING TO WRITE FOR!” I’m sure that DDS’s and CNM’s have their reasons for needing prescriptive authority, they could at least do their profession some justice by not sloppily abusing that privilege.
The other end of the spectrum is when MD/NP/PA’s write for Lipitor and check the little idiot “Do Not Substitute (DNS)” box. Uh, is there a generic out for Lipitor? Why are you preventing me from switching to a generic that hasn’t even come out yet? Do you even know what that little box does? Obviously not. Single-source drugs (meaning drugs that come from one source, hence the name) doesn’t require you to check the little “DNS” box because there isn’t anything to substitute them for (hence, single source)!
Then you call the doctor up and call him on it because obviously the insurance company is NOT going to pay for a brand name that costs 100x more than the generic just because he checked a little box. What response did you get? “Oh, the generic is fine.” I really feel like answering “WASTE MORE OF MY TIME BY CHECKING THAT MOTHERFUCKING BOX YOU ASSHOLE!!” Doctors can be so damn frustrating at times. All that college and they can’t understand a simple concept like the DNS box on their Rx pads.
Don’t get me started on OB/GYN’s and checking that fucking box on prenatal vitamins or iron tablets.
If the state allowed us to switch a non-covered brand to a class-equivalent brand/generic (meaning switch the whole drug to another in the same class) then I can see them checking the box for everything. However we can’t switch drugs, so checking that box just because you have no idea what it means just makes yourself look like an idiot.
This has been a Public Service Announcement by The Angry Pharmacist.