Yes, at least in certain circumstances, with the following considerations in mind.
In regards to when a pharmacist can make a generic substitution without consulting the prescriber, Minn. Stats. Section 151.21 uses the phrases (emphasis added):
“a less expensive
generically equivalent drug that, in the
pharmacist's professional judgment, is
safely interchangeable with the prescribed drug,” and
“A pharmacist may not substitute a
generically equivalent drug product unless, in the
pharmacist's professional judgment, the substituted drug is
therapeutically equivalent and interchangeable to the prescribed drug.”
Consequently, a pharmacist is not required to use the Orange Book when making generic substitutions. However, pharmacists have to have some sort of basis for their “professional judgment.” If the Orange Book is not consulted, or if the Orange Book does not list the generic as being therapeutically equivalent to the brand name product, the pharmacist should have some other, legitimate and documented basis for concluding that a drug is generically and therapeutically equivalent to the drug prescribed – and that it is safely interchangeable. If pharmacists do not have a documented basis for substitution, they should contact the prescriber for approval of the substitution and document this on the prescription.
In January 2017 Mylan began supplying an authorized generic for EpiPen. According to a document that Mylan sent to the Board, these two products are generically and therapeutically equivalent. In fact, they are identical products – except for the labeling. In this case a pharmacist may substitute the authorized Mylan generic for the EpiPen without consulting the prescriber
According to the Orange Book, EpiPen and Adrenaclick have a BX rating, meaning that insufficient evidence exists to show that the two products are therapeutically equivalent. Consequently, pharmacists would need permission from the prescriber to substitute Adrenaclick (or its authorized generic) if EpiPen is prescribed (and vice versa) –
unless pharmacists have another credible and documented reason for determining that EpiPen and Adrenaclick are therapeutically equivalent and safely interchangeable.
Since the instructions for use are slightly different for the various epinephrine auto-injectors, it is important for pharmacists to counsel patients on proper use, especially when making a generic substitution.
For further information on “authorized generics” please see the Orange Book Preface.