Utilization effects of Rx-OTC switches and implications for future switches

Abstract

We examined the effect of over-the-counter (OTC) conversion of prescription drugs on utilization at the drug class level using monthly drug utilization data from the US for the period 1999-2010 for 9 drug classes: antihistamines, benign prostatic hyperplasia medication, cholesterol control drugs (statins), analgesics (triptans), contraception medications (emergency contraception), antiulcerants (proton pump inhibitors) non-sedating antihistamines, weight-loss remedies and erectile dysfunction remedies. We performed interrupted time series analysis to detect a break in the trend of drug utilization following OTC introduction. We found that the introduction of the first OTC drug increased drug utilization at the class level by an average of 30% or more. We concluded that OTC switches can be an important policy tool for improving public health in drug classes where a significant proportion of the population is untreated and where consumers can effectively manage treatment with limited physician supervision.

Share and Cite:

Stomberg, C. , Philipson, T. , Albaugh, M. and Sood, N. (2013) Utilization effects of Rx-OTC switches and implications for future switches. Health, 5, 1667-1680. doi: 10.4236/health.2013.510225.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Consumer Healthcare Products Association (2012) Rx-toOTC Switch.
http://www.chpa-info.org/scienceregulatory/Switch_SR.aspx
[2] Freudenheim, M. (2003) Claritin’s price falls, but drug costs more. The New York Times.
[3] Goldman, D.P., Joyce, G.F., et al. (2007) Prescription drug cost sharing: Associations with medication and medical utilization and spending and health. JAMA, 298, 61-69.
[4] Pierce, J.P. and Gilpin, E.A. (2002) Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking. JAMA, 288, 1260-1264.
[5] Reed, M.B., et al. (2005) The effect of over-the-counter sales of the nicotine patch and nicotine gum on smoking cessation in California. Cancer Epidemiology, Biomarkers & Prevention, 14, 2131-2136.
http://dx.doi.org/10.1158/1055-9965.EPI-04-0919
[6] Moreau, C., Bajos, N. and Trussell, J. (2006). The impact of pharmacy access to emergency contraceptive pills in France. Contraception, 73, 602-608.
http://dx.doi.org/10.1016/j.contraception.2006.01.012
[7] Sood, N., et al. (2008) Potential effects of introducing behind the counter drugs. RAND Working Paper.
[8] Sood, N., Sun, E., et al. (2012). Behind-the-counter statins: A silver bullet for reducing costs and increasing access? Health Services Research, 47, 174-187.
http://dx.doi.org/10.1111/j.1475-6773.2011.01315.x
[9] Gurwitz, J.H., McLaughlin, T.J., et al. (1995). The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: The case of vaginal antifungal products. Health Services Research, 30, 672-685.
[10] Sullivan, P.W., Nair, K.V., et al. (2005) The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy. American Journal of Managed Care, 11, 374-382.
[11] Furler, M.D., Rolnick, M.S., et al. (2002) Cost impact of switching histamine(2)-receptor antagonists to nonprescription status. The Annals of Pharmacotherapy, 36, 1135-1141. http://dx.doi.org/10.1345/aph.1A231
[12] Filion, K., et al. (2007) The impact of over-the-counter simvastatin on the number of statin prescriptions in the United Kingdom: A view from the general practice research database. Pharmacology and Drug Safety, 16, 1-4.
http://dx.doi.org/10.1002/pds.1314
[13] Walker, R. and Hinchliffe, A. (2010) Prescribing and sale of ophthalmic chloramphenicol following reclassification to over-the-counter availability. International Journal of Pharmacy Practice, 18, 269-274.
http://dx.doi.org/10.1111/ijpp.18.05.00046.x
[14] Sullivan, P.W., Follin, S.L., et al. (2003) Transitioning the second-generation antihistamines to over-the-counter status: A cost-effectiveness analysis. Medical Care, 41, 1382-1395.
http://dx.doi.org/10.1097/01.MLR.0000100584.18276.C4
[15] Stead, L.F., et al. (2008) Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 1, Article ID: CD000146.
http://dx.doi.org/10.1002/14651858.CD000146.pub3
[16] Raymond, E.G., Trussell, J., et al. (2007). Population effect of increased access to emergency contraceptive pills: A systematic review. Obstetrics & Gynecology, 109, 181-188.
http://dx.doi.org/10.1097/01.AOG.0000250904.06923.4a
[17] Polis, C.B., Schaffer, K., et al. (2007). Advance provision of emergency contraception for pregnancy prevention: A meta-analysis. Obstetrics & Gynecology, 110, 1379-1388.
http://dx.doi.org/10.1097/01.AOG.0000295603.84568.f6
[18] Lakdawalla, D., et al. (2006) Intellectual property and marketing. NBER Working Paper.
[19] Brass, E.P. (2004) Consumer behavior in the setting of over-the-counter statin availability: Lessons from the consumer use study of OTC Mevacor. American Journal of Cardiology, 94, 22F-29F.
http://dx.doi.org/10.1016/j.amjcard.2004.07.051
[20] Melin, J.M., Struble, W.E., et al. (2004) A consumer use study of over-the-counter lovastatin (CUSTOM). American Journal of Cardiology, 94, 1243-1248.
http://dx.doi.org/10.1016/j.amjcard.2004.08.007
[21] Brass, E.P., et al. (2008) Can consumers self-select for appropriate use of an over-the-counter statin? The self evaluation of Lovastatin to enhance cholesterol treatment study. American Journal of Cardiology, 101, 1448-1455.
http://dx.doi.org/10.1016/j.amjcard.2008.01.020
[22] Kline and Company (2010) Rx-to-OTC Forecasts USA 2010. Kline & Company, Inc., Report no. #Y406C.
http://www.klinegroup.com/reports/brochures/y406c/brochure.pdf
[23] Brass, E.P., et al. (2006) Potential impact on cardiovascular public health of over-the-counter statin availability. American Journal of Cardiology, 97, 851-856.
http://dx.doi.org/10.1016/j.amjcard.2005.10.022
[24] Straka, R., et al. (2007) Economic impacts attributable to the early clinical benefit of atorvastatin therapy—A US managed care perspective. Current Medical Research and Opinion, 23, 1517-1529.
http://dx.doi.org/10.1185/030079907X199808
[25] Cardozo, L., et al. (2010) The cost-effectiveness of solifenacin vs fesoterodine, oxybutynin immediate-release, propiverine, tolterodine, extended-release and tolterodine immediate-release in the treatment of patients with overactive bladder in the UK National Health Service. British Journal of Urology International, 106, 506-514.
http://dx.doi.org/10.1111/j.1464-410X.2009.09160.x
[26] Clemens, J. (2011) Factors associated with work productivity impairment in subjects with overactive bladder. Presentation, AMCP 23rd Annual Meeting, Minneapolis, 27-29 April 2011.
[27] US Census Bureau (2010) Income, poverty, and health insurance coverage in the United States: 2009. Bureau of Labor Statistics, Labor Force Participation Rate Series.
[28] Lipton, R., et al. (2007) Migraine prevalence, disease burden, and the need for preventative therapy. Neurology, 68, 343-350.
http://dx.doi.org/10.1212/01.wnl.0000252808.97649.21
[29] Hu, X., et al. (1999) Burden of migraine in the United States—Disability and economic costs. Archives of Internal Medicine, 159, 813-818.
http://dx.doi.org/10.1001/archinte.159.8.813
[30] Lipton, R., et al. (2002) Migraine in the United States: Epidemiology and patterns of access to care. Neurology, 58, 885-894. http://dx.doi.org/10.1212/WNL.58.6.885
[31] Cambpell, N., et al. (2012) Internet-ordered viagra (sildenafil citrate) is rarely genuine. Presentation, American Urological Association 2012 Annual Meeting, Atlanta, 19-23 May 2012.
[32] Jackson, G., et al. (2010) Counterfeit phosphodisterase type 5 inhibitors pose significant safety risks. International Journal of Clinical Practice, 64, 497-504.
http://dx.doi.org/10.1111/j.1742-1241.2009.02328.x
[33] Smith, K. and Roberts, M. (2000) The Cost-Effectiveness of Sildenafil. The Annals of Internal Medicine, 132, 933-937.
http://dx.doi.org/10.7326/0003-4819-132-12-200006200-00002
[34] Shaw, M.J., Fendrick, A.M., et al. (2001) Self-reported effectiveness and physician consultation rate in users of over-the-counter histamine-2 receptor antagonists. The American Journal of Gastroenterologyl, 96, 673-676.
http://dx.doi.org/10.1111/j.1572-0241.2001.03602.x

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.