What drugs should be OTC?

22 Dec
2003

There’s a Blurry Line Between Rx and O.T.C.

The decision to sell a drug by prescription, experts say, may involve factors that have nothing to do with science or patient safety. Marketing and financial considerations, politics, doctors’ concerns and consumer psychology all may play a role.

“Unequivocally, there is no bright line,” said Peter Barton Hutt, a former chief counsel at the F.D.A. who now teaches at Harvard and represents drug companies. “It’s a judgment issue.”

This article focuses on the “morning after” pill, but we could write similar pieces on Prilosec or Claritin.

Each of these decisions brings mixed feelings. On the one hand, many drugs are safe enough and beneficial enough that patients should not need my permission to take them. However, self medication does carry dangers. Patients do not always understand warning signs. We see patients who self medicate for longer than is prudent.

I suspect we will continue to have angst over each of these decisions.

Just to complicate matters, patient insurance muddies the waters. Many patients only have prescription drugs covered. Thus, rather than take Prilosec OTC (for 70 cents a day) they want the little purple abomination (at over $4 a day). But then they do not pay.

In other cases, straightforward commercial considerations can determine how a company wants a drug classified. For example, drug manufacturers know that patients with drug coverage often prefer prescriptions to paying the full cost of over-the-counter drugs.

Doctors say they see this insurance effect all the time. Dr. James Osborne, an internist in Greensboro, N.C., says when patients with occasional heartburn ask for a prescription for Nexium, he often suggests they buy Pepsid, which costs 24 cents a day for the four pills needed to equal prescription strength, or about 17 times less than Nexium. “They say, ‘It doesn’t matter, doc. I have a drug card,’ ” Dr. Osborne said.

Maybe we need to restructure how we think about OTC and prescription drugs. Maybe we need less dichotomy here. But I cannot figure out how to modify the current structure.

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2 Responses to What drugs should be OTC?

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Fakeo Nameo

December 22nd, 2003 at 11:16 am

Every few years I travel to an area that has malaria. I always look up what the CDC is recommending for that area, then make a doctor’s appointment. Then I explain to my doctor where I am going, they look up the same info and write the script. Then I have to fight with my insurance company to pay for it. “Let me get this straight, you will cover me if I get malaria, but you don’t want to pay for the pills to prevent it?” They usually come through. If I didn’t have to start the series before I left, I would just buy what I needed over the counter in the country when I arrived. I would cost much less and the health outcome would be the same. Obviously I am in favor of more OTC drugs.

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John Anderson

December 22nd, 2003 at 3:33 pm

Can’t a prescription for OTC be written? After all, I heard recently that one of the pharmas was going to market a prescription sugar-pill (placebo) for doctors who have hypochondriac patients. I want a prescription for M&M’s!