Virginia Senate bill, sponsored by Sen. Favola, proposes expanded pharmacist discretion on drug substitution

State Sen. Barbara A. Favola has introduced legislation designed to provide pharmacists with increased discretion in substituting medications to help boost patient access and address drug shortages, the Virginia State Senate reports.

This proposal, SB418, was brought forward on Jan. 14, 2026, during the 2026 regular session and is formally described as: “Therapeutic interchange; authorizes pharmacists to perform, adaptation of prescriptions.”

The summary provided here is based on the official text of the legislation, with additional explanation for clarity.

Under the bill’s terms, pharmacists could substitute a prescribed medication with another in the same therapeutic class if, in their clinical judgment, the replacement offers a comparable outcome and side effect profile at a similar dosage. Substitution would be permitted when it results in equal or reduced patient costs or during shortages recognized by the FDA or ASHP. The bill further allows pharmacists to make adaptations such as altering drug names, strengths, instructions, dosage forms or the prescribed quantity, or filling in missing prescription details when justified by the evidence. Notification to the prescriber must occur within 24 hours of making a substitution. Additional changes would update restricted acts to acknowledge these new pharmacist authorities and require the Board of Pharmacy to outline which drug classes may or may not be interchanged.

Sen. Barbara A. Favola (Democrat-40th District) is the sole sponsor of this bill.

Since convening this session, Favola has introduced 18 additional pieces of legislation.

She earned a BS from Saint Joseph College in 1977.

Favola, a member of the Democratic Party, was elected to the Virginia State Senate in 2024 to represent District 40, following former state senator Todd Pillion.

In Virginia, a bill enters the process when introduced in either legislative chamber. It is then assigned to committees for review and amendment. Favorable committee action advances a bill to floor debate and a vote in both chambers. If approved in both, the bill proceeds to the governor, who may sign it into law, veto it, or allow it to become law without a signature. The Virginia General Assembly holds its annual regular session beginning the second Monday in January, with hundreds of bills considered—although only a fraction become law.