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Executive Summary

IOWA PHARMACISTS WOULD BE ALLOWED TO SELECT THERAPEUTIC ALTERNATIVES to an Rx when authorized by the prescriber, under legislation that cleared the Iowa General Assembly May 3. The measure passed the State's House May 2 by a vote of 85-12, and the Senate May 3 by a 30-18 vote. It was sent to Iowa's GOP Gov. Terry Branstad for his consideration. Pfizer, Lilly and other Rx drug mfrs. oppose the measure. The legislation, introduced on behalf of the Iowa Pharmacists Assn. by Rep. Bob Arnold (D-Davenport) as House File (HF) 315, would, if okayed by Branstad, legitimize practices of hospital pharmacists who work off of formulary systems, the Iowa assn.'s Exec Director Thomas Temple said. The authority for pharmacists to select therapeutic alternates could also apply to other authorized health-care settings, such as HMOs and clinics, Temple explained. Community pharmacists could also select therapeutic alternates under HF 315 if they dispensed drugs for an HMO whose physicians had authorized such substitution, Temple said. Joining the Iowa Pharmacists Assn. in support of the legislation was the lowa Medical Society and Iowa Hospital Assn. Temple reported that Iowa's Board of Pharmacy Examiners and Board of Medical Examiners would, under the legislation, jointly adopt rules to regulate the practice of selecting therapeutic alternates. Another provision of HF 315 would modify Iowa's drug-product-selection law by permitting the pharmacist to keep up to 50% of the savings between a prescribed brandname drug and a dispensed generic, instead of requiring him to pass on the full difference. This provision would give the pharmacist incentive to stock generic equivalents, as well as provide savings to patients, Temple said. HF 315 would also repeal a requirement for a "negative formulary" which since 1976 has listed "nonequivalent" drug products under the selection law; the legislation would give pharmacists an opportunity to exercise professional judgment for drug substitution without the negative formulary.

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