Opinions of pharmacy, medicine, and pharmaceutical industry leaders about hypothetical therapeutic-interchange legislation.

The beliefs of representatives of organized pharmacy and medicine and the pharmaceutical industry about the effect of hypothetical therapeutic-interchange legislation on various health-care issues were studied. Questionnaires designed to gauge respondents' beliefs about the impact of two hypothetical bills (A and B) concerning selection of therapeutic alternates by pharmacists were mailed to the directors of 307 organizations in April 1986. Bill A would permit pharmacists in any setting to select therapeutic alternates. Bill B would permit therapeutic interchange by pharmacists within organized health-care settings in accordance with guidelines approved by physicians. Issues addressed included the efficient delivery of health care, professional liability, interprofessional and pharmacist-patient relationships, and competition and profitability in the pharmaceutical industry. The response rate was 63% (194 usable responses). Bill A received some support from representatives of state pharmaceutical associations only. However, bill B was supported by respondents from state pharmaceutical associations, state hospital pharmacy societies, boards of pharmacy, and generic manufacturers. Respondents from medical associations and member companies of the Pharmaceutical Manufacturers Association (PMA) were concerned about the impact of the hypothetical bills on the quality of drug therapy and the efficiency of health-care delivery. Respondents from medical associations also were concerned about the impact of the bills on physician liability. The responses from the medical associations and the PMA-member companies suggest that a program should be developed to educate physicians about the process used by pharmacists and physicians to develop guidelines for therapeutic interchange in various practice settings.