Product Substitutions and Other RX Changes Without MD Input

I understand you can substitute ProAir 8.5gm for Ventolin 90mcg/actuation 18gm if the MD specified 8.5gm, the active ingredient being bioequivalent. How far can you take this sort of liberty before insurance or the MD gets upset? What are the limits for the pharmacist to purview these things? Thanks!
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Source Type: forums