Pharmacy rules by state

California lets a pharmacist substitute a cheaper generic unless the prescriber forbids it, requires almost all prescriptions to be sent electronically, gives pharmacists unusually wide authority to furnish medicines directly, and runs one of the most active boards of pharmacy in the country.

Florida requires pharmacists to substitute a cheaper generic unless the prescriber writes that the brand is medically necessary, lets patients refuse the substitution, allows pharmacists to test and treat some minor conditions, and runs a prescription monitoring program that must be checked for most controlled substances.

Georgia allows generic substitution unless the prescriber writes that the brand is necessary, requires a check of the state prescription monitoring program before many controlled prescriptions, has a naloxone standing order, and had no state insulin cap in force when this guide was checked.

Illinois allows generic substitution unless the prescriber indicates the brand is required, caps insulin cost-sharing on state-regulated plans at one of the lowest levels in the country, requires controlled-substance prescriptions to be electronic, and regulates pharmacy through the Department of Financial and Professional Regulation.

Michigan allows generic substitution unless the prescriber writes dispense as written, has required almost all prescriptions to be electronic since 2021, is one of the few states that schedules gabapentin as a controlled substance, and limits first opioid prescriptions for acute pain.

New Jersey requires generic substitution unless the prescriber marks do not substitute, has moved to electronic prescribing, limits first opioid prescriptions to five days, caps insulin and some other cost-sharing on state-regulated plans, and lets pharmacists provide hormonal contraception under a recent law.

New York requires generic substitution unless the prescriber signs the dispense-as-written box, was the first state to require all prescriptions to be electronic, and has eliminated insulin cost-sharing on state-regulated plans. Pharmacy is regulated by the State Education Department’s Office of the Professions rather than a stand-alone board.

North Carolina allows generic substitution unless the prescriber indicates the brand is medically necessary, limits first opioid prescriptions under the STOP Act, requires controlled-substance prescriptions to be electronic, and lets pharmacists prescribe hormonal contraception under a standing order.

Ohio lets a pharmacist substitute a generic unless the prescriber writes dispense as written, runs one of the longest-established prescription monitoring programs, limits first opioid prescriptions for acute pain, requires gabapentin dispensing to be reported, and had no state insulin cap in force when this guide was checked.

Pennsylvania lets a pharmacist substitute a generic unless the prescriber writes that the brand is medically necessary, requires controlled-substance prescriptions to be electronic, has no state insulin cap in force, and regulates pharmacy through a board under the Department of State.

Texas allows generic substitution unless the prescriber writes that the brand is necessary, requires controlled-substance prescriptions to be electronic, caps insulin cost-sharing on state-regulated plans, and has a board of pharmacy with a straightforward public licence lookup.

Virginia allows generic substitution unless the prescriber writes brand medically necessary, schedules gabapentin as a controlled substance, requires opioid prescriptions to be electronic, limits first opioid prescriptions for acute pain, and caps insulin cost-sharing on state-regulated plans.