Switching prescription drugs to over the counter

Editor—Cohen et al say that switching drugs to over the counter increases costs for most insured patients in the United States because of resultant changes in drug benefits.¹ Most health plans restrict drug coverage and increase copayments when one member of the class is made available over the counter. However, evidence from recent switches from prescription to over the counter shows that patients benefit financially despite such restrictions and increased copayments.

Figure 1.

Credit: TIM BOYLE/GETTY IMAGES

The switch of loratadine has been shown to be cost effective for consumers, insurers, and society.²,³ An examination of the average out of pocket cost for second generation antihistamines shows that health plan members paid less for loratadine after it was made available over the counter. Previously at least one second generation antihistamine was available through most health plans as a preferred brand product, with a copayment of some $17 (£8.99; €13.11) per month.⁴ Recent pricing for generic over the counter loratadine (10 mg once a day = $8.50/month; www.drugstore.com, 10 Jan 2005) shows that it is much less expensive than the average copayment before the switch. In addition, the price of over the counter omeprazole (20 mg once a day = $19 per month; www.drugstore.com, 10 Jan 2005) is equivalent to the average copayment in 2003 for preferred branded drugs ($19).⁵

However, the opportunity cost of obtaining a prescription drug must include the time cost of the doctor and pharmacy visit (two to three hours at $20 per hour).³ Although some insured patients may suffer from loss of coverage or higher out of pocket costs, evidence from the most recent switches from prescription to over the counter in the United States shows that most insured (and uninsured, as argued by Cohen et al) patients benefit financially from over the counter availability.