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October 2, 1981

Drug Substitution Encouraged by Law

Author Affiliations

Southfield, Mich

JAMA. 1981;246(14):1545. doi:10.1001/jama.1981.03320140033013

To the Editor.—  We have previously cautioned that generic levothyroxine sodium tablets are not always equivalent to a brand name product. We stressed that until such time that levothyroxine products become more uniform, physicians, pharmacists, and legislators should not encourage product switching (1980;244:1704). We suspect that other generic drugs may also not always be equivalent to brand name products. Current regulatory agencies seem unable to monitor adequately and ensure uniformity of the vast number of generic drugs.The 1981 state of Michigan fiscal appropriation bill for social services provides a Medicaid pharmaceutical dispensing fee of $2.65 when a generic drug is dispensed and $2.15 when a brand name drug is dispensed. A 50-cent copayment per prescription is required from Medicaid patients older than 21 years when some brand name drugs are dispensed where generic equivalents are available. "The copayment may be requested by the pharmacy before filling the prescription and,