Should Most Common Prescriptions Be Over the Counter?
In a move generating some expected controversy the Obama administrations health wizards are contemplating releasing many common prescription medications to over the counter status.
| FDA may let patients buy drugs without prescriptions... |
Various hypertension, diabetes, cholesterol, migraine, and asthma medications are being considered and pharmacists are excited about the expansion of their roles. Many primary care doctors are not happy about this potential move though.
Pharmacists and other non physician practitioners have the knowledge and skill to address mild and moderate issues which will result in cost savings to the feds. They also do not have the experience to appreciate potentially deadly issues at the same level as MD's. The convenience to patients will be offset by the probable increased cost of these meds and the insurance companies will not cover many of them anymore. I mostly agree with this pharmacist here,
"We think it’s a great development for everybody — for pharmacists, for patients and the whole health care system,” said Brian Gallagher, a lobbyist for the American Pharmacists Association. “The way we look at it is there are a lot of people out there with chronic conditions that are undertreated and this would enable the pharmacists to redirect these undertreated people back into the health care system.”
The article also quotes internal medicine physicians and I agree with this statement.
“The problem is medicine is just not that simple,” said Dr. Matthew Mintz, an internist at George Washington University Hospital. “You can’t just follow rules and weigh all the pros and cons. It needs to be individualized.”
Here's how I see this for primary care. One of the few ways private docs survive is the easy meat of medicine. A common cold, routine medication checks, follow up blood pressure/diabetes/cholesterol etc. The infirmed and elderly take far more time (and time is all we have to charge for unlike many specialties) and the compensation is just abysmal for a lengthy consult, often not even covering the overhead of the office let alone any profit. People buying OTC meds for serious issues will often expect a doctor to pick up the phone for free and talk to them about it, fat chance in our brave new world, and people will be lucky to even get a secretary to acknowledge a question and put it in the pile of 100 daily issues that the doc will never get to. Primary care will end up all government, hospital or insurance employees if they have no entrepreneurial spirit or go full private no insurance and charge what the market will bear. The last scenario is what I do now but the feds are always threatening to shut us outside the box people down even though we still are out earned by all the subspecialties, especially procedural based ones. The feds just cannot stand anyone in medicine beyond their control. If this happens then getting to a doctor for any routine item will be impossible as no one but a pure masochist would ever enter the worst paying field (with the most paperwork also) of medicine.
So we have pros and cons regarding this bold step. On many levels I am for the move. Of course the administration never dreams of real tort reform which would generate a 15% savings at a minimum, but that topic is for another day.
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Comments:
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
I'm going to stake out the extreme end of the debate. I don't think the state has any business telling people what they can and cannot buy, and what people can and cannot sell to people. (I'll add to that must and must not.)
It seems like pharmacists, being professionals, can determine their own business practices, and patients can make their own choices without the mommy state telling people they need a permission slip from a grown up before they can buy something.
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
In theory, this is a great step. If primary care physicians are in such short supply in America, it is perverse not to tap into the underutilized expertise of pharmacists. Many of them have doctoral degrees in pharmacy yet do little more than tell you what time of day to take a pill: an utter waste of resources.
What disturbs me is that this move reeks of nothing more than a cost-cutting measure to save Medicare. Incremental market liberalization is worse than useless if the core market is still horribly slanted by government intervention. In other words, making prescription drugs OTC (and thus not covered by most insurance) will only work if there is an open market for primary care as well.
In a comprehensive health care reform, access to medications without a doctor's visit will be very beneficial. But this move is little more than government rationing, pushed onto the consumer to make it look like "free choice" and keep their own hands free of blood.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
I agree with you Fred, but who will the people sue when their kidneys fail?
To counter the full measure of your argument I am pretty sure some of the powerful drugs of abuse need to be kept away from the oxycontin addicts of the world. Until we get to the point where vehicular manslaughter under the influence is replaced by murder 2 and life in jail I have little comfort turning my scheduled drugs over to the masses. One of the controls on misuse and abuse of narcotics etc is us. The level of danger for these meds are dramatically under appreciated and deaths are fairly common due to misuse.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
Of course we should have some OTC medicines for common items. I think we should rely on pharmacists more for proper dosages of routine medications.
I dont think that this would end the routine work for the doctors, it would just change the nature of the work. We would go from a system of advise and gatekeep to one of advise.
I think a cortiosteroid, Adderall, an antibiotic, and birth control would cover most routine stuff and reduce a huge amount we overspend on medicine.
I worry about cholesteral medication because it drove my grandpa insane (yes lipitor made my grandpa lose all connection to rationality) but I dont know the wider context.
I dont appreciate on principle the idea that I have to pay gatekeepers. I am perfectly fine with paying for advice, but the idea that I have to pay someone to give me permission to buy something I already know I need is maddening.
You know the idea that I could call a doctor and get them to work for free is not something that has ever crossed my mind.
Edited on April 30, 2012 at 8:38pmMar '11
Re: Should Most Common Prescriptions Be Over the Counter?
Fred Cole:
It seems like pharmacists, being professionals, can determine their own business practices, and patients can make their own choices without the mommy state telling people they need a permission slip from a grown up before they can buy something.
I agree with you in theory, but in this situation we need to look at the context.
Most of the drugs in question here are for chronic conditions. I imagine that a patient needing these medications might also desire the occassional small lab work by his doctor to see whether he even needs the medication anymore, and if so at what dose.
In an unregulated medical market, this might be a fairly inexpensive proposition. However, in our Medicare-dominated world, getting some simple bloodwork done is time-consuming for the patient, expensive for the third-party payer, and barely lucrative for the MD.
Healthcare involves multiple markets acting in coordination. As long as the caregiver side of the equation is in a regulatory straightjacket, providing more free choice to the pharmacy side of the equation will do little to improve the situation.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Well Guru, the cholesterol meds have some sneaky side effects that I think are under reported yet you put an amphetamine in your list, :) , which is harsher than lipitor by a mile. People get a hold of those and use it like meth, often staying awake for days and going insane. Those with legitimate adhd issues are less prone to go nuts with such meds.
To count on average people, including the ignorant masses, to use controlled substances properly is a pipe dream. The cons outweigh the pros here for me but I could deal with it. Of course I'd need a spot blood/urine check on anyone driving my kid to feel OK and employers would need to test pre hire and everyday of work for legal reasons....it get's complicated.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Mendel
Fred Cole:
It seems like pharmacists, being professionals, can determine their own business practices, and patients can make their own choices without the mommy state telling people they need a permission slip from a grown up before they can buy something.
I agree with you in theory, but in this situation we need to look at the context.
Most of the drugs in question here are for chronic conditions. I imagine that a patient needing these medications might also desire the occassional small lab work by his doctor to see whether he even needs the medication anymore, and if so at what dose.
In an unregulated medical market, this might be a fairly inexpensive proposition. However, in our Medicare-dominated world, getting some simple bloodwork done is time-consuming for the patient, expensive for the third-party payer, and barely lucrative for the MD.
Healthcare involves multiple markets acting in coordination. As long as the caregiver side of the equation is in a regulatory straightjacket, providing more free choice to the pharmacy side of the equation will do little to improve the situation. · 2 minutes ago
A very astute set of points Mendel.
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
Depends on the circumstances. If I were to take a mess of Tylenol and wash it down with a tall glass of Jack Daniels, and were to suffer some horrific damage, then I have no one to blame buy myself.
Some of it falls into the category of caveat emptor.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
DocJay: Well Guru, the cholesterol meds have some sneaky side effects that I think are under reported yet you put an amphetamine in your list, :) , which is harsher than lipitor by a mile. People get a hold of those and use it like meth, often staying awake for days and going insane. Those with legitimate adhd issues are less prone to go nuts with such meds.
To count on average people, including the ignorant masses, to use controlled substances properly is a pipe dream. The cons outweigh the pros here for me but I could deal with it. Of course I'd need a spot blood/urine check on anyone driving my kid to feel OK and employers would need to test pre hire and everyday of work for legal reasons....it get's complicated. · 3 minutes ago
Tweekers are in the process of getting your hand sanitizer controlled like they do draino and cold medicine. One can't legislate away the world based upon the cleverness of addicts.
Cortiosteroids make me sick as hell too, but it makes my list as well. I am not sure how I feel about blood pressure medication, I am not necessarily against it.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
My argument against controlled substances being OTC runs along the same logic as why I cannot go down to the store and pick up mortars, machine guns , dynamite, cyanide, and chemical weapons.
Steroids are tricky drugs with tremendous benefits as well as substantial side effects. I'm on the fence with that one.
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
Having read the article linked in DocJay's post, I am even more convinced that this is a thinly-veiled attempt to shore up the finances of government-provided healthcare (ie Medicare) and keep it solvent.
Consider:
1) More drugs available without an Rx means fewer doctor visits - saves Medicare money.
2) Many forms of Medicare don't cover OTC medications, or if so only after a doctor's recommendation (see point 1)
3) The Obama administration is willingly devolving medical decision making from experts to the consumer. Really? Seriously?
This proposal is a way for the government to ration healthcare without leaving any fingerprints. Let's not get suckered in.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
DocJay: My argument against controlled substances being OTC runs along the same logic as why I cannot go down to the store and pick up mortars, machine guns , dynamite, cyanide, and chemical weapons.
Steroids are tricky drugs with tremendous benefits as well as substantial side effects. I'm on the fence with that one. · 2 minutes ago
They make me really sick. I got prescribed my first batch when I got some poison ivy on my face and genitals (terrible). I had to scrap the pill series against the advice of my doctor. The next time they got prescribed it wasnt so bad, and that was for an ulnar neuropathy. I like a non-tingly pinky finger. Tingling extremities are not something to be trifled with when you are a man with a less than super diet, so I had no problem with the doctor's visit for that one.
Edited on April 30, 2012 at 9:18pmMay '11
Re: Should Most Common Prescriptions Be Over the Counter?
Isn't this just a way for pharmaceuticals to get rid of the middle man in this case doctors and sell directly to the consumer? Pharmaceutical companies for the last few years have taken on a more active role of suggesting which drugs consumers should take. Think of all the ads for new drugs. At the end of the commercial they always suggest "ask your doctor about fill in the blank drug." Derugulate the process of having to get a prescription and you'll get more use of the drugs that are advertised. Seems like a great deregulation for the pharmaceutical companies.
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
Not necessarily. Consider that most Medicare and private insurers don't pay for OTC medications. Deregulation would have the net effect of increasing drug prices for patients (at least short-medium term), thus discouraging consumption.
Also remember that drug companies do a great job of overcharging Medicare for many of their products. Through their immense lobbying power, they probably have a much better racket selling to the government than to individual customers.
Edited on April 30, 2012 at 9:23pmNov '11
Re: Should Most Common Prescriptions Be Over the Counter?
So, you're see yeast infection cream the same way you see a machine gun?
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Fred Cole
So, you're see yeast infection cream the same way you see a machine gun? · 1 minute ago
Last I checked, Monostat 3 never killed anyone. I've seen a number of deaths from controlled substances though. Morphine OTC for an 18 year old makes as much sense as dynamite OTC to me.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
DocJay:
Primary care will end up all government, hospital or insurance employees if they have no entrepreneurial spirit or go full private no insurance and charge what the market will bear.
Or as concierge medicine, as it is increasingly practiced here in SW Florida. (Both of my parents are concierge patients). Very relevant post, Doc!
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Here's the rub. The OTC ones won't be the newer designer ones. Those drugs will be Dr ordered only but with 5 pages of pre-authorization and justifications. If I want to order Dexilant ( an acid pill superior to prilosec or prevacid OTC) then you first must prescribe, then receive a denial, then file an appeal, then receive the appeal form, then fill it out at great time expenditure, then have it denied anyway, then call them up and get put on hold for 20 minutes, then get the RN and I pitch the case and maybe they say yes or no depending on whether or not Their criteria are met. Sometimes the answer is never no matter how much documentation. It often takes hours of uncompensated time per medication.
Edited on April 30, 2012 at 10:10pmDec '11
Re: Should Most Common Prescriptions Be Over the Counter?
I think quibbling over what should be on such a new theoretical list does not do much to advance the cause of why such a list is a good or bad idea.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Good point Guru, that was the idea of the original post. I am really looking for some of the passionate to chime in about the actual article. You and Fred had valid points about some of the serious drugs( him more so in the pure libertarian sense....surprise!) and I felt I'd be remiss in not responding.
I know your feelings on the matter which is generally in support of this measure.
I mostly agree with the concept put forth in the proposal but tried to think of the usual unintended consequences.
Our system is going bust. No minor tweaking will save it and obamacare accelerates the demise. Radical change is needed and sometimes taking a chance and seeing the results over time is the solution.
Tort reform is the no brainer that will never happen by the way.
Getting the government out of the way will save the system but access will change for the negative and those unable to care for themselves will be in a world of trouble (as they will be under the obamacare model in due time as well)
Edited on April 30, 2012 at 10:40pm