Who may substitute, and when
A written policy — formulary equivalents, prescriber-notification rule, patient-consent line — turns counter improvisation into governed practice. Without it, every substitution is an individual pharmacist’s legal exposure.
The prescriber stays in the loop
Substitution the prescriber discovers later corrodes exactly the referral relationship the pharmacy depends on. A same-day notification — even automated — keeps the substitution clinical rather than commercial.
| Item | Standard | Consequence / owner |
|---|---|---|
| Equivalence list | Formulary-approved pairs only | Pharmacy committee |
| Prescriber notice | Same day, recorded | Automated message |
| Patient consent | Informed at counter | Dispensing step |
| Bill disclosure | Both names + difference shown | Billing print |
| Exception log | Refusals and reasons kept | Pharmacy register |
Price transparency closes the loop
When the substitution saves the patient money, say so on the bill: prescribed brand, dispensed equivalent, difference. The transparency converts a suspicion moment into a trust moment.
What to do on Monday
- Draft the one-page policy with the committee this month.
- Automate the prescriber notification.
- Add the both-names line to the pharmacy bill.
Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.