Virginia Law

A. A pharmacist may perform a therapeutic interchange by substituting a drug with another drug in the same therapeutic class that the pharmacist believes will have a similar therapeutic effect and adverse-reaction profile when administered in a therapeutically equivalent dose as the prescribed drug, provided that the substitution lowers the cost or is cost-neutral to the patient or occurs during a drug shortage, and the substitution is made in accordance with Board regulations.

For purposes of this section, a drug shall be deemed to be in a drug shortage when such drug appears on either the (i) U.S. Food and Drug Administration drug shortage list or (ii) American Society of Health System Pharmacists drug shortage list.

B. A pharmacist may adapt a prescription drug order by:

1. Changing the drug name, strength, directions, or quantity of medication prescribed when performing a therapeutic interchange in accordance with Board regulations;

2. Changing the dosage form of a prescription if it is in the best interest of patient care, so long as the prescriber's directions are also modified to equate to an equivalent amount of drug dispensed as prescribed;

3. Changing the quantity of medication prescribed if the prescribed quantity or package size is not commercially available or the change in quantity is related to a change in dosage form as authorized by this subsection; or

4. Completing missing information on a prescription if there is evidence to support the change.

C. If a pharmacist performs a therapeutic interchange, the pharmacist shall notify the prescriber within 24 hours of such change being made.

D. Nothing in this section shall be construed to prevent a prescriber from indicating that substitutions for the prescribed drug are not appropriate by checking the "Dispense as Written" box.

2026, c. 888.