1. (a) A pharmacist whose practice is located within this state may substitute medications for therapeutically equivalent medications.

2. (b) However, a pharmacist shall not substitute a medication for a therapeutically equivalent medication if:

   1. (1) A prescription is in writing and the prescriber indicates in his or her own handwriting by name or initial that no substitution is to be made;
   2. (2) A prescription is not in writing and the prescriber expressly indicates that the prescription is to be dispensed as communicated; or

   3. (3)

      1. (A) The Arkansas State Board of Pharmacy has:

3. (i) Determined that a therapeutically equivalent medication should not be substituted; and

   1. (ii) Notified all pharmacists of that determination.

      1. (B) Examples include but are not limited to any:

         1. (i) Antipsychotics;
         2. (ii) Antidepressants;
         3. (iii) Controlled substances; and
         4. (iv) Oncolytic agents.
         5. (c) Therapeutic equivalence may be established with clinical publications comparing dosages of drugs in a therapeutic class.
         6. (d)

   2. (1) Before dispensing, the pharmacist shall:

      1. (A) Discuss verbally any suggested substitution with the patient; and
      2. (B) Inform the patient that the patient has a right to refuse the substitution.

   3. (2) This discussion shall include without limitation:

      1. (A) Notification to the patient that the therapeutically equivalent drug does not contain the identical active ingredient present in the prescribed drug; and
      2. (B) All differences in dosage and frequency between the prescribed drug and the therapeutically equivalent drug.
4. (e) The pharmacist shall send notice of the substitution to the prescriber in writing or by electronic communication within twenty-four (24) hours after the drug is dispensed to the patient.
5. (f) This section does not apply to specific acts of drug therapy management or disease state management delegated to a pharmacist based upon a written protocol or patient care plan approved by a physician under Arkansas Code § 17-92-101(18)(A)(ix);

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: “(Adopted 12/29/2014, Amended 5/10/2022)"