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According to the US FDA, therapeutic equivalents are drug products that have been approved and their pharmaceutical equivalents (for which bioequivalence has successfully been demonstrated) have been established. These products would have the same safety profile and clinical effect. The therapeutic equivalence code is one that is assigned to an FDA-approved product which determines that they are “therapeutically equivalent” to another pharmaceutically equivalent drug products.

The code provides additional information that is based on the US FDA’s evaluation of the product. The US FDA provides its evaluations for therapeutic equivalence in the Orange Book through multi-letter codes that are assigned to multi-source products. This coding system allows users to determine if the FDA has evaluated a product as therapeutically equivalent to another pharmaceutical equivalent product.

What is the Therapeutic Equivalence Coding System?

The first letter of the code indicates that the US FDA has determined that the approved product is therapeutically equivalent to another product. The system uses additional specific letters to provide more information based on the Agency’s evaluations. The US FDA has a guideline in place to support stakeholders in navigating the FDA’s evaluation of the therapeutic equivalence.

Products that are assigned the letter A as the first letter means that the FDA considers them to be therapeutically equivalent to other pharmaceutically equivalent products. Products that are assigned the letter B as the first letter means that bioequivalence related problems have not yet been resolved or there is not enough evidence to demonstrate bioequivalence.

In some cases, a number may be added to certain codes to give three-character codes which are assigned in situation where there is more than 1 Reference Listed Drug (RLD) of the same strength which has been designated under the same product heading in the Orange Book.

What is the importance of therapeutic Equivalence Code of the US FDA?

The importance of the Therapeutic Equivalence Code lies in its role in pharmacy practice and public health. By providing a clear and standardized method for identifying equivalent medications, the FDA helps facilitate the substitution of generic drugs for brand-name drugs, which can lead to significant cost savings for patients and the healthcare system. This is particularly important in the United States, where the cost of prescription medications is a major concern for many people.

Roles and Function

The roles and functions of the Therapeutic Equivalence Code extend beyond just facilitating drug substitution. It also plays a key role in the regulatory oversight of medications. By assigning these codes, the FDA monitors the quality, efficacy, and safety of drugs on the market, ensuring that any generic drug deemed therapeutically equivalent meets strict standards. This process involves rigorous evaluation of the generic drug's active ingredients, dosage form, strength, route of administration, and bioequivalence to the brand-name drug.

Furthermore, the Therapeutic Equivalence Code is a valuable tool for healthcare professionals in prescribing medications. It aids pharmacists in identifying suitable generic alternatives that can be offered to patients, ensuring that they receive effective treatment while potentially reducing costs. For prescribers, understanding these codes is crucial for making informed choices about medication therapy, especially when managing patients with chronic conditions who may be on multiple medications.


The Therapeutic Equivalence Code of the U.S. FDA is a foundational element in the regulation and safe use of medications. Its importance cannot be overstated, as it ensures that drugs deemed equivalent are truly comparable in their safety and effectiveness. The roles and functions of this coding system are multifaceted, supporting not only cost-effective healthcare by enabling drug substitution but also maintaining high standards of drug quality and safety. By leveraging this system, healthcare providers can make informed decisions that optimize patient care and outcomes.

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