In any therapeutic interchange solicitation, the following shall be disclosed to the prescriber: that a therapeutic interchange is being solicited, the circumstances under which the originally prescribed drug will be covered by the purchaser, the difference in copayments or coinsurance to be paid by the beneficiary to obtain the proposed drug, the circumstances and extent to which health care costs related to the therapeutic interchange will be compensated, and any clinically significant differences, as determined by a pharmacy and therapeutics committee of the pharmacy benefits manager, with respect to efficacy, side effects, and potential impact on health and safety.