Request By:
Rodney D. Jewell, R.Ph.
Begley Drug Company No. 10
616-7 Main Street
Stanford, Kentucky 40484
Opinion
Opinion By: Robert F. Stephens, Attorney General; By: George Geoghegan, III, Assistant Attorney General
This is in answer to your letter dated April 5, 1977, in which you inquired whether the abbreviation "DNS" is sufficient indication that there should be no substitution of the brand name drug under KRS 217.822.
In OAG 76-758, this office opined that under KRS 217.822, a physician could indicate in any manner he chose that the generic equivalent drug should not be substituted. However, the last act in so indicating should be completed at the time of issuing and writing the prescription. This would permit a form to have "Do Not Substitute" preprinted on it together with a box in blank for the physician to indicate whether it is appropriate in the particular case.
In OAG 77-223, this office opined that when the prescription involved a medical assistance patient, the pharmacist would not be able to recover any amount over and above "MAC" price unless the physician indicated in his own handwriting that there was to be no substitution. Where medical assistance patients are concerned, the physician is required to do more than is necessary under KRS 217.822 when indicating that substitution is not appropriate. Not only must the physician indicate it, he must so indicate it in his own handwriting.
"DNS" is an abbreviation for "Do Not Substitute". It is apparent that this is generally known throughout the medical and pharmaceutical professions.
Therefore, it is our opinion that the abbreviation "DNS" is sufficient to indicate to the pharmacist that there is to be no substitution of a generic equivalent drug. Insofar as KRS 217.822 is concerned, a pharmacist would not be authorized to substitute a generic equivalent drug if the physician indicated on his prescription that there was to be no substitution by checking a box at the side of a preprinted abbreviation "DNS". On the other hand, this would not authorize a pharmacist to receive over and above the "MAC" price on a prescription for a medical assistance patient. The prescription for the medical assistance patient requires more of the physician. He must write the abbreviation "DNS" in his own handwriting.
Before closing, we opine that any abbreviation, phrase, clause or statement which is generally known throughout the medical and pharmaceutical professions as meaning "Do Not Substitute" would also be sufficient.