The next time you receive a written prescription, take a look at where your doctor signed it. Most prescription pads have two lines for the doctors signature: under one line are the words Dispense as Written, and under the other line are the words Substitution Permissible. These phrases can vary slightly. Dispense as Written is occasionally shortened to As Written, or sometimes changed to Brand Necessary. Substitution Permissible is sometimes written as May Substitute.

Regardless of the exact phrases that are used, these terms indicate whether or not a pharmacy can use the generic version of a drug when they fill a prescription. When doctors write prescriptions, they often write the name of the brand-name medication . . . even if they intend for you to receive the generic version. For instance, many doctors have been prescribing the cholesterol medication Lipitor for years. When generic Lipitor becomes available in a couple of years, most doctors wont begin writing on prescriptions. Theyll just continue to write as they always have, knowing that pharmacies will use the generic version.

This may sound simple enough, but many doctors are actually confused about the exact meaning of these terms. For example, I constantly see prescriptions signed Dispense as Written for drugs that arent even available generically. Obviously, the doctors who write these prescriptions arent intending to tell me that I cant use the generic version . . . when its not even available. Instead, these doctors are often intending to inform the pharmacy that its not acceptable to switch to another drug in the same class.

So, if a doctor signs a Lipitor prescription on the Dispense as Written line, he may be trying to tell the pharmacy that its not acceptable to switch his patient to Zocor, Crestor, or any of the other available drugs in this class. However, your pharmacy cant switch your prescription to a different drug without first asking your doctors permission. So, signing on this line actually accomplishes nothing. In fact, there are a couple of situations where this might actually raise your prescription costs.

Situation #1: A Generic Version Has Just Been Released
At my pharmacy, Ill occasionally encounter prescriptions that have been signed on the Dispense as Written line for drugs that have just recently become available generically.

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