Utah Legislature considers establishing easier medication substitution system to lessen prescription delays and affordability issues


Maddie McCarthy


Utah Rep. Raymond P. Ward (R-Davis County) is looking to expand access to medication through pharmacy amendments with House Bill 132.

The bill seeks to establish a more accessible way for prescribers and pharmacies to communicate about medication substitutions, and provides substitution guidelines for physicians and pharmacists in order to ensure patients are not affected by pricing or coverage issues.

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“A prescriber will write a prescription for a patient, and may have spent a lot of time trying to convince them to take it or to resolve their concerns and explain all the options available to them,” Ward said at the Utah House Health and Human Services Committee hearing last week, during which lawmakers unanimously passed the legislation.

“[They] make a decision, send a prescription to the pharmacy, but when the patient gets there, they are told, ‘Oh, no, that’s not covered by your insurance. That one is going to be very expensive. You can’t pick that one up.’ And the patient leaves empty-handed.”

When something like this happens, there is a back and forth process with the pharmacy and the prescriber to fix the problem, which causes a delay for the patient, and sometimes the patient may end up never getting the medication.

Ward said this happens more often with some medications than others, one being insulin.

“Even when the prescriber meant for it to be substituted for a different form of insulin and even when they indicated that on the script, it doesn’t get substituted,” he said.

There is a generic substitution system in place under the US Food and Drug Administration (FDA). They have a list of approved drugs that are the therapeutic equivalent to their name brand counterparts. 

HB 132 would require Utah to create a list of therapeutically similar drugs, which are different from therapeutically equivalent drugs. The dosage, active ingredients, or way of administration may be different, but the drug does the same thing as its therapeutically similar counterpart.

The list would be created by the Division of Professional Licensing, the Osteopathic Physician and Surgeons Licensing Board, the Physicians Licensing Board, and the Pharmacy Board. Each party would have full veto power, so all must agree that a therapeutically similar drug can be added to the list.

Ward said this would create a system that allows prescribers and pharmacists to be able to communicate better so they can provide for the patient in the best way possible.

“In this other system, if [the medications] are very similar, the prescriber has to write on the script so there is no accident that they sent it to the pharmacy and it got substituted and they didn’t mean it. They actively have to write on the prescription, ‘therapeutically similar substitution permitted.’ 

So they have to know what is on that list, they have to know what they want, and they have to put it on the script and then the pharmacist would be able to know … The pharmacist then has to communicate back to [the prescriber] about which one from that list that they substituted.”

— Ward

The bill would also require the division to work with the boards to come up with its own therapeutic equivalent list.

“[The bill] says, ‘We may have some medicines we want to add to that federal list that we consider equivalent that act just like those other generics,’” Ward said.

The Utah Legislature did this with albuterol in 2020 by allowing the division to add therapeutically equivalent substitutes for the drug onto the list of equivalents, but Ward wants medications on this new list to not have to individually go through the legislature.

Michelle McOmber, chief executive officer of the Utah Medical Association, spoke in support of the bill.

“We appreciate the representative working through our concerns with this and putting in language that we think works for physicians,” she said.

Stephanie Arceneaux, outreach lead and member of the Federal Working Group for T1 International, Utah #insulin4all Chapter, also supported the bill, especially because of its specification to include insulin and diabetes test strips.

“This bill will help to ensure that individuals with diabetes don’t have to leave the pharmacy without what they need to survive,” she said.

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