What Is Therapeutic Interchange?

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  • Written By: Marlene Garcia
  • Edited By: Daniel Lindley
  • Last Modified Date: 22 November 2019
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Therapeutic interchange permits substituting a drug with a different chemical composition that might work as well as more expensive medication. Hospitals and long-term care facilities might use therapeutic interchange to keep expenses down, especially for patients who use multiple medications. The practice gives pharmacists the authority to dispense more affordable medication not considered a therapeutic equivalent drug. Laws regulating therapeutic interchange might vary widely by region.

A therapeutic equivalent usually includes a generic drug formulated after a patent expires on brand-name medication. Pharmacists commonly refer to lists of drugs costing less that have been tested for safety and effectiveness. Substitution of these drugs might be required by some health insurance companies. The prescribing doctor usually indicates on the prescription if a brand name medication is medically necessary, meaning the pharmacist may not make substitutions.

Therapeutic interchange goes beyond the practice of substituting generic drugs manufactured with the same formula as its patented form. It permits using certain classes of drugs for individual patients if the cheaper drug might also prove effective. Written approval from a doctor and strict guidelines typically regulate the use of therapeutic interchange.

In nursing homes where the practice is permitted, a committee typically oversees the use of alternative medicine. This group sets guidelines and selects drugs for the program after weighing cost, effectiveness, and safety. The committee monitors the practice and determines which patients and medical conditions might benefit from using drugs that cost less.


While evaluating drugs suitable for substitution, the committee considers the availability of drugs deemed therapeutic equivalents. The group also looks at agents added to certain medications, such as preservatives, that might cause adverse allergic reactions. Managed care health plans typically favor therapeutic interchange but might dictate specific acceptable formulas.

Once a doctor gives written approval for these substitutions, a pharmacist working in a nursing home or hospital might dispense the medication at his or her discretion. The pharmacist commonly monitors the patient to determine if the drug works as intended at the dosage prescribed. Prior medical approval usually applies to each patient and each drug dispensed. A pharmacist typically reports any serious problems to the doctor who approved therapeutic interchange.


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