Under what condition can a pharmacist substitute a generic drug for a brand-name drug?

A pharmacist can substitute a generic drug for a brand-name drug under specific conditions that ensure the safety and effectiveness of the substitution. The correct scenario is when the DAW (Dispense as Written) box is empty, and the drug is therapeutically equivalent. This means that the prescriber has not indicated any restrictions against substituting the brand-name drug and has allowed for the possibility of using a generic alternative that is chemically identical and provides the same therapeutic effect.

Therapeutic equivalence refers to medications that can be expected to have the same clinical effect and safety profile when administered to patients under the conditions specified in the labeling. When the prescriber does not prohibit the substitution—indicated by leaving the DAW box empty—the pharmacist can legally and ethically switch to a generic that meets these equivalence requirements. This practice not only saves on costs for patients but also promotes the use of equally effective medications.

Substituting drugs under unauthorized conditions, such as without the prescriber's consent or when the drugs are not therapeutically equivalent, could compromise patient safety and violate legal regulations surrounding pharmaceutical practice.