The purpose of this study was to asses the rate and the trend of foreign drug

substitution by community pharmacies in Palestine, and to analyze the legal issues

influencing prescription substitution such as physicians' acceptance. The study was

made on a randomly selected list of foreign drugs. A total of 1425 prescriptions from

twenty community pharmacies were analyzed for foreign drug substitution. The

substitution rate was 25.8%. More than 58% of these substitutions were agreed by the

prescribing physician. The most commonly substituted drugs were those that have a

price difference compared with the local product equivalents. This study shows that

foreign drug substitution in Palestine is common and mostly encouraged by patients to

reduce prescription costs. This study also, shows that there is a need to modify the

existing pharmacy practice law regarding brand name substitution.