Price ratios are cost signals, not substitution advice

A ratio is not a recommendation

A price-ratio table can show that the unit price of one strength does not scale cleanly with another strength. That is useful information, but it is not therapeutic advice. It does not prove that splitting, combining strengths, or changing the dispensed strength is clinically acceptable.

The ratio should be treated as a flag for review, not as a command to change the prescription.

Clinical checks come first

Before any cost-driven substitution is considered, the pharmacy must consider whether the tablet is scored, whether the dose can be safely split, whether the product formulation allows splitting, whether the patient can manage the regimen, and whether the prescriber’s instruction permits the change.

For controlled-release products, narrow therapeutic index drugs, adherence-sensitive regimens, complex tapers, and patients with difficulty handling tablets, a price signal may be irrelevant.

How to use the table safely

Use the table to identify a possible discussion point. Confirm clinical appropriateness. Confirm current formulary pricing. Confirm the prescriber instruction. Document the reason if a change is made. When the answer is uncertain, leave the prescription as written and use the table only as background information.

The safest interpretation is simple: the price-ratio tab shows where cost behaves oddly. It does not decide what the patient should receive.