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:
Dec '10
Re: Should Most Common Prescriptions Be Over the Counter?
If Walmart and other super stores are still doing $4 or $5 generics I don't see the consumers suffering too much financially.
Maybe I'm simply detached from the issue. Is it normal to hit 40 with zero chronic health prescriptions?
May '10
Re: Should Most Common Prescriptions Be Over the Counter?
Get your new bumper stickers!
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
I am passionate. We talk about how much americans spend on health care, and I know how much time my doctor is going to spend with me after I wait 2 hours because he is behind, to engage in an act that is solely for the purposes of gatekeeping.
I think a good theoretical starting point with our winnowing forks, is probably drugs which are taken appropriately in which the not extremely unlikly side effects stop when you stop taking the drug. For instance cortiosteriods make me sick, when I stop taking them I stop being sick.
Drugs which have serious side effects which do not stop after taking the drug normally, should probably be gatekeeped.
Drugs that are part of the treatment of an extreme medical condition. For instance one isnt going to goto the doctor for morphine to take care of a condition. You are going to get morphine because you had your arm ripped off by some machinery, and its use will be part of a larger treatment scheme.
Edited on April 30, 2012 at 11:13pmAug '10
Re: Should Most Common Prescriptions Be Over the Counter?
Depends on which drugs.
Antibiotics? Probably not.
Narcotics, like Adderall (amphetamine)? Probably not.
Viagra? Hmm...
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
KP, those $4 ones may fall by the wayside. Keep exercising and eating well and you'll stay clear of our poisons.
EJ Hill, every place you enter here is a ray of sunshine.
Aug '10
Re: Should Most Common Prescriptions Be Over the Counter?
The list already exists. Some drugs are by prescription, others aren't.
The whole debate is merely quibbling over which drugs should be on which list.
Unless one believes that all drugs should be over-the-counter.
Edited on April 30, 2012 at 11:15pmMar '11
Re: Should Most Common Prescriptions Be Over the Counter?
I've already given my 2 cents, but this issue riles me up enough to give the other $3.65:
Allowing most drugs which are not addictive, do not cause drastic alterations in consciousness, and do not promote microbial resistance to be sold OTC (or with a pharmacist's approval) is a great idea.
The problem would be implementing this change now. Our Kafkaesque maze of payment structures is crowding out what should be the most cost-effective type of doctor in any healthcare market: the primary care physician.
Letting PCPs keep one monopoly (writing prescriptions for common medications) because we have artificially removed their other sources of revenue is a poor solution at best. But I fear that driving the last PCPs into extinction will make any shift to a liberalized healthcare market even more difficult if and when comprehensive reform ever occurs.
I would love to be proven wrong on this.
Edited on April 30, 2012 at 11:22pmMay '10
Re: Should Most Common Prescriptions Be Over the Counter?
It's the law of unintended consequence. Let's face it, the first time a drug causes an unwanted side-effect or death the pharmacist will be sued.
"Are you trained to diagnose and dispense drugs, Mr. Doe?"
"No sir, I did not make the diagnosis."
"Then why did you sell the victim these drugs? Did you know what other medications the late Mr. Smith was on?"
"No, sir."
"Did you know that Mr. Smith had a history of low blood pressure and that the dosage of that medicine could kill him?"
"But the federal government...."
"The federal government did not authorize you to kill Mr. Smith! Ladies and Gentlemen of the jury..."
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
I doubt you are wrong Mendel. I think drugs for many common conditions should be more available too which may be on the other side of most docs. I suppose the PCP's will have to find a way to roll with the punches once more. Just because their (my former) lives are in trouble does not justify not implementing a potentially dramatic cost saving measure. That's too much protectiveness for my liking.
Aug '10
Re: Should Most Common Prescriptions Be Over the Counter?
I'd be happy with giving nurse practitioners more authority to prescribe drugs, and/or giving pharmacists more authority to refill prescriptions.
I hate having to wait at my doctor's office just to get a refill on a long-term prescription. The actual visit with the doc is about 5 minutes.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
Misthiocracy
The list already exists. Some drugs are by prescription, others aren't.
Thewhole debateis merely quibbling over which drugs should be on which list.
Unless one believes that all drugs should be over-the-counter. · 19 minutes ago
Edited 18 minutes ago
Ideally, yes, the federal government shouldnt have a lot to say about what drugs you ingest.
I would certainly support such a law if it contained a provision stating that the individual taking the drug is civilly and criminally liable for ingesting the drug and any resulting positive or negative outcomes.
I am just not dogmatically married to it.
Edited on April 30, 2012 at 11:52pmNov '10
Re: Should Most Common Prescriptions Be Over the Counter?
From the libertarian perspective it's a good idea. However, look to a huge expansion of problems arising from drug interactions. This isn't a simple matter of more versus less regulation, or whether or not druggists have the expertise to advise. It places a lot of onus on patients to know when something might be a problem. There are internet sites, for example, that might be used to discover potential problems with drug interactions, but there's a pretty big energy and education barrier against the average Joe/Jane going there on their own initiative.
Druggists might like the increased role, but they will have to carry much higher liability insurance, which will surely increase costs (maybe a tradeoff for dispensing fees).
Probably there is a good list of things that shouldn't be restricted. But others that should, for medical reasons. I'm probably swimming against the libertarian stream here but I believe that patient drug data should be centralized, but with access controlled by the patient. In today's information economy it should be easy enough to implement in a way that's inexpensive and relatively painless for all concerned.
Aug '10
Re: Should Most Common Prescriptions Be Over the Counter?
R. Craigen:
There are internet sites, for example, that might be used to discover potential problems with drug interactions, but there's a pretty big energy and education barrier against the average Joe/Jane going there on their own initiative.
<devil's advocate mode = on>
There are also other websites that give really, really, really bad information about drugs and other pharmaceutical ingredients. Just look at the bogus autism-vaccines stuff that's out there.
<devil's advocate mode = off>
May '10
Re: Should Most Common Prescriptions Be Over the Counter?
If they enact this, maybe I will also be able to once again get effective Sudafed without a strip-search and background check....
Aug '11
Re: Should Most Common Prescriptions Be Over the Counter?
I think America is overmedicated. We want an easy cure, a pill, and we want it now. The next thing you know, we're managing conflicting meds and feeling worse and worse. And this fact ignores the "if one is good, two is better" school of hypochondriac medicine. The body is an amazing vehicle and it will build a tolerence to most poisons, which means to the hypochondraic, the two pills I used to take no longer work, so I'm stepping up to three. Infectious agents grow drug resistent as well. Drug companies want to sell pills, so we can expect no help from them. The answer?
Very few medications should be OTC. No narcotics, anti-biotics, mood enhancers, relaxants, stimulents stronger than coffee, diet pills, ADHD drugs, depressants, anti-depressants or drugs with significant side effects or risks of interaction. We need to wean people off prescription drugs, not open up the Pharmacy to self-medicators.
Edited on May 1, 2012 at 12:45amSep '10
Re: Should Most Common Prescriptions Be Over the Counter?
I'm honestly shocked. The FDA sounds as if they are moving off my eliminate this dept list. I was under the impression that they were moving the direction that europe was going in trying to make vitamin supplements require prescriptions.
Who knew, maybe the FLOTUS is doing some good for once. However I want that choice made for myself.
I say this because this is one of the few moves this administration has accomplished that moves in the opposite direction of centralization.
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
I don't care why the government is doing it. I care that it is happening. Mendel's summary is perfect:
But I would add one other caveat: Patients and their families must be able to sign a binding legal waiver that ends their right to sue if and when they choose to take a drug that is not approved and/or prescribed. This would mean that people would be able to choose for themselves whether to try a radical new therapy. It would do wonders for new drug development and availability.
Aug '11
Re: Should Most Common Prescriptions Be Over the Counter?
iWc: I don't carewhy the government is doing it. I care that it is happening. Mendel's summary isperfect:
But I would add one other caveat: Patients and their families mustbe able to sign a binding legal waiver that ends their right to sue if and when they choose to take a drug that is not approved and/or prescribed. This would mean that people would be able to choose for themselves whether to try a radical new therapy. It would do wonders for new drug development and availability. · 9 minutes ago
We have this now - in the supplements market. I'm afraid very few persription drugs would meet the criteria you cite, at least the drugs that people want to take, that do not currently have a supplement doppelganger that serves the same purpose.
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
Doug Kimball
iWc:
But I would add one other caveat: Patients and their families mustbe able to sign a binding legal waiver that ends their right to sue if and when they choose to take a drug that is not approved and/or prescribed. This would mean that people would be able to choose for themselves whether to try a radical new therapy. It would do wonders for new drug development and availability. · 9 minutes ago
We have this now - in the supplements market. I'm afraid very few persription drugs would meet the criteria you cite, at least the drugs that people want to take, that do not currently have a supplement doppelganger that serves the same purpose. · 9 minutes ago
I should have been more clear: in the case of a life-ending illness (Alzheimers or cancer, for example), only the legal waiver criterium would apply.
Feb '12
Re: Should Most Common Prescriptions Be Over the Counter?
Put me on Mendel's side. I hate the fact that I can't get my anti-depressants because I can't afford a $10/min appointment to get a new "permission slip." (Perfect analogy, BTW)
Transcript from my last appointment:
"Nothing's changed since the last appointment, doc; I'm just here for more drugs. At least it's sertraline. Oh, and this clinic has decided it can't afford to give free psychiatric appointments to suicidally depressed unemployed lawyers. Can you give me a script for more than 30 days?"
As for checking for drug interactions, that's what pharmacists *do*. They generally understand those interactions better than the family malpractice doc. Heck, one of the local pharmacy's ads pitches is essentially "Trust us to catch the drug interactions your doctor was too ignorant to notice."