ICHP Position Statement - Therapeutic Interchange

The Illinois Council of Health-System Pharmacists (ICHP) supports the practice of therapeutic interchange as a process that potentially increases access to, controls costs of, and improves patient outcomes of medications.

Therapeutic interchange occurs when an authorized therapeutically equivalent medication is dispensed in place of the specific medication prescribed. Therapeutic equivalents are medications that differ in chemical composition or are different medication entities considered to have similar pharmacologic and /or therapeutic actions. Often, one medication is switched with another medication within the same therapeutic class, or from another medication class but with the same pharmacologic effect.

Therapeutic equivalence and interchange amongst products is mutually agreed upon by pharmacists and prescribers, frequently through written guidelines, protocols, or a collaborative practice agreement approved by the Pharmacy and Therapeutics Committee (or equivalent).

The assessment of therapeutic interchanges is a key component of a health system’s ongoing formulary management process, which demands the active input of interdisciplinary health professionals, and is evidence-based.


  1. Vanderholm T, Klepser D, Adams AJ.  State approaches to therapeutic interchange in community pharmacy settings:  legislative and regulatory authority.  J Manag Care Spec Pharm 2018;24 (12):1260-1263.
  2. Gray T, Bertch K, Galt K, Gonyeau M, et al.  Guidelines for therapeutic interchange-2004.  Pharmacotherapy 2005;25(11):1666-1680.
  3. Anon. Therapeutic interchange 6/1/19. AMCP policy. https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements/therapeutic interchange-0 (last accessed 3/25/2021).
  4. Holmes DR, Becker JA, Granger CB, Limacher MC, et all.  ACCP/AHA 2011 Health Policy Statement on Therapeutic Interchange and Substitution.  A report of the American College of Cardiology Foundation Clinical Quality Committee.  Circulation 2011;124:1290-1310.

Revised 09/2014

Revised 01/2018

Revised 04/2021