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Executive Summary

PROPRANOLOL GENERIC SUBSTITUTIONS FOR INDERAL RE-INFARCTION INDICATION would not increase pharmacist liability risks, the California Pharmacists Assn. (CPhA) President John Berger declared in a recent news release. Responding to concern that pharmacists could face uninsured liability for dispensing generic propranolol for use by post-infarction patients, CPhA President Berger said: "Drugs which are lawfully on the market, approved for one indication, may be lawfully prescribed for other unapproved indications." Berger noted that "Inderal, in fact, was used for a number of years in the successful treatment of post-MI patients before the FDA granted it an approved labelling indication for that purpose." Berger's letter responds directly to a "generic alert" letter sent to pharmacists in California by a group called the Pharmacists Planning Service, Inc. (PPSI). Pointing out the exclusive myocardial infarction for Inderal, PPSI maintained: "You, the pharmacist, may be at risk by dispensing a generic product if the branded product has been prescribed." The threat of uninsured liability from propranolol substitution "is false," CPhA said. The assn. president called the claim "the worst kind of professional scare tactic." Berger said: "Pharmacists should not be misled by this blatant misconstruction of the law." The CPhA president said: "A pharmacist may legally dispense a brand other than the one prescribed if the drug is the same generic drug type and the same dosage form and strength, unless the physician specifically prohibits use of a generic." Berger added that the pharmacist is not required to check on the diagnosis behind an Rx. "In fact," he said, "there is no requirement that the physician or the patient inform the "pharmacist of the diagnosis even if it is requested." Ayerst will inform MDs of the exclusive Inderal indication, Berger contended. "If the cardiologist is concerned that other propranolols may be less safe or effective, he or she may foreclose brand interchange by an indication on the Rx," Berger said.

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