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Your pharmacy is substituting generic levothyroxine tablets – or lower-cost brands like Unithroid® or Levoxyl®  -- for more expensive brand name levothyroxine like Synthroid®, Tirosint®, or Tirosint®-SOL.



Your doctor has not specified the brand in a way that prevents the pharmacy from substituting with generic levothyroxine.


Every state except Oklahoma permits a pharmacy to substitute a generic even when your doctor has written a prescription for a brand name drug. (Note: Some states even REQUIRE it. These include Florida, Kentucky, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Washington, and West Virginia.)

To get the brand name you need -- versus the generic or a cheaper brand -- you need to ask your doctor to write the prescription in a way that prohibits substitution with a generic or lower-cost drug. That means, the doctor needs to use the required terminology for your state on your prescription.

It’s typically one of the following statements:

  • Brand medically necessary

  • No substitution

  • Substitution Not Allowed

  • DAW / Dispense as Written

In addition, some prescription pads and systems provide a box or place to check off either “No substitution” or "Dispense as Written." 


Ask your physician to write your brand name levothyroxine prescription in a way that prevents substitution by the pharmacist in your state. 

For more information, you may want to review this guide on how to prevent substitution.

An Important Note: It is NEVER legal for a pharmacy to substitute brand name or generic levothyroxine tablets for Tirosint® or Tirosint®-SOL. While generic and brand-name levothyroxine tablets are all rated by the FDA as AB equivalent to each other, tablet forms of levothyroxine are NOT rated by the FDA as AB equivalent to Tirosint® capsules or Tirosint®-SOL oral solution. Legally, a pharmacist can’t substitute tablets for any form of Tirosint®. (That doesn’t always stop them from still trying, however!)

Also, be aware that if your insurance company refuses to cover a medically-necessary brand name drug, you should file a complaint with the company to review the decision.


The Levothyroxine Deep Dive program is copyright © 2020, Mary Shomon. All rights reserved.

Levoxyl®, Synthroid®, Tirosint®, Tirosint-SOL®, and Unithroid® are registered trademarks. Product images and logos used with permission. 


Mary Shomon does not provide medical advice, diagnosis or treatment.


The contents of this video and material contained on the website ("content") are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned from this video or site.

If you think you may have a medical emergency, call your doctor or 911 immediately. Mary Shomon does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by Mary Shomon is solely at your own risk.

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