Take Two and Call Your Doctor in the Morning for a Prescription Refill

September 18, 2009 10:41 AM

I am trying to determine the cost of keeping drugs that are available without prescriptions in other countries prescription-only in the US. Please point me towards any studies that have attempted to calculate this or data that might help me calculate it myself.

In the US, a large number of drugs require a doctor's prescription. Many of those drugs are available either over-the-counter or behind-the-counter (from a pharmacist) without a prescription in other countries. For example, cough suppressants containing codeine are prescription-only in the US, but behind-the-counter in many European countries.

What I'm looking for are some numbers that would help to quantify the marginal costs of these additional prescription restrictions in the US. The obvious costs would come in the cost of doctor's visits to obtain prescriptions, processing, and monitoring of the prescription system, but there may be other costs I'm not thinking of.

If there's a study that attempts to do this, I haven't been able to find it (perhaps it's buried under all of the Google results for "BUY VIAGRA WITHOUT A PRESCRIPTION IN MEXICO!!!"). Any information would be much appreciated.

posted by decathecting to health & fitness (8 comments total)

There are also hidden costs involved in making a prescription drug an over- or behind-the-counter drug, such as those arising from potential misuse, abuse, or dependence. These will vary according to the abuse potential of different drugs, and in a few cases these may outweigh the marginal cost of obtaining and processing a prescription.

Also, when analyzing this question, consider than the cost of the "prescription strength" versions of drugs that are also available without prescriptions can be substantially lower when available only by prescription. For example, Tylenol with codeine (available OTC as well as by Rx in Canada) is vastly cheaper than the regular bottles of Tylenol or store-brand acetaminophen, and I have found the same to be true for the stronger prescription-only doses of Advil.
posted by onshi at 11:48 AM on September 18

I think you need to target your question more or broaden your reasearch.

I am not sure if you are making a claim that that more medicines are OTC outside of the USA. I would rexamine it if you are. The range of OTC drugs in the USA is wider if you think outside the example you have quoted. That example has more to do with the craziness of US drug enforcement laws than healthcare. A counterexample would be the range of topical ointments including steroids and anti infectives available in the US is far wider than what you would find in the UK for example. Also, Zantac went OTC in the US before Europe and my guess is so did Zocor and Alli.

I dont think any comparison you may make between US and Europe on the actual costs to the end user will not be meaningful (but cost to the system might be but harder to obtain) because most people in Europe dont pay for the consultation and or prescription or pay a flat fee unrelated to the price of the drug (around GBP 7 in the UK). This cost reflects filling costs and not the cost of the drug.
posted by london302 at 1:44 PM on September 18

cost of doctor's visits to obtain prescriptions
Out of curiosity, do you have to go to the doctor every time you need a repeat prescription? For stable long-term conditions here like asthma you can get a refill when you run out just by dropping a repeat slip into the doctors. They check it over to make sure you're not over-using or anything like that, and you do have to have check-ups, but you don't have to see the doctor every time.

As london302 says, this really isn't going to be a useful comparison. The price the NHS pays for prescription drugs is I believe almost always lower than the US prescription cost anyway, and I think the same is true for most other 'western' countries. So a 'like for like' is probably impossible.

Secondly, drugs are often called by different names - the generic names should be the same, but they may be known by brand names that are different (I spent years wondering what this 'Tylenol' stuff was, before finding out it was paracetamol!). This alone will cause you a load of extra work.

I've just grabbed my out of date paper copy of the British National Formulary, which gives all the drugs prescribable on the NHS (including OTC ones that can also be prescribed) - over 600 pages of drugs (with uses), in rather small text. This is not a small undertaking...
posted by Coobeastie at 2:42 PM on September 18

I'm not actually looking for a comparison with other countries on dollar amounts. And I understand that what I'm trying to do won't encompass all of the costs and benefits of various drug schemes. But I suppose what I'd like to create is something like this:

1) A list of drugs that are prescription-only in the US, but that some other country has decided to make available without a doctor's permission.

2) An accounting of the costs to patients associated with procuring each of those drugs in the US.

If I can get this sort of information even for just one drug, that would be helpful for my purposes. So, for example, how much do Americans spend on doctor's visits to obtain codeine? I'll take any hard data I can get my hands on. I just need some numbers!
posted by decathecting at 3:46 PM on September 18

I'd also take information, if it's available, about drugs that were formerly prescription and are now over-the-counter. So, for example, what was the change in costs for those taking Claritin when it was prescription-only, as opposed to now when they can buy it OTC? Any numbers would be helpful.
posted by decathecting at 3:48 PM on September 18

Are you interested in costs to patients or costs to the government? The systems elsewhere can be very different to yours which reduces or increases costs to both in various ways.

For example, here in NZ it's way way cheaper for me to get pretty much anything on prescription rather than OTC because it's subsidised by the government. Example, my antihistamines cost $3 after my free Dr visit or about $60 for the same amount OTC. It's not like that for everyone here, I have a Community Services card (i.e. a type of low income card) plus I'm a University student so my doctor's visits are partially subsidised by my Uni fees, but any eligible citizen gets at least some government funding and the $3 fee is apparently common.

Also in general prescription drugs are much cheaper here than they are in the USA because our government controls the cost of medicine. An organisation called Pharmac negotiates with each drug company and sets how much they're prepared to pay and how much they subsidise for the public. It's all listed in their schedule, this is where you'd find out what drugs are available on prescription in NZ (note: it can be possible to prescribe drugs not on the schedule but I don't know how often it's done) and how much they are subsidised by (from which you can work out the overall cost). I'm not sure where you'd get a comparison of OTC prices, maybe just by looking at online pharmacies, but they're generally the same or more expensive.

So the whole paradigm here is different. Having overall government control of prescription costs plus prescription subsidisation changes things quite a lot and I don't think we're the only country that does these things. I don't know how relevant it is to what you're interested in since it's tangential to the question of OTC drugs, but if you're looking at comparing different countries then I think overall cost structures and funding models is something you should consider.
posted by shelleycat at 8:49 PM on September 18

I'm interested in costs to patients and their insurance companies. I don't care at all what it costs to provide drugs in countries with different payment schemes. I am not looking to compare different countries. I'm interested in the difference in costs between prescription and nonprescription drugs, focusing on drugs that require prescriptions in the US but not elsewhere.
posted by decathecting at 9:19 PM on September 18

I'm interested in costs to patients and their insurance companies.

I don't have or need an insurance company, my drugs are mostly paid for by my government. How does that part fit in? Also the cost to the patient in many countries is directly regulated by the government, so the funding scheme matters.

Searching for prescription costs otc in google scholar and pub med brought up a bunch of articles and there is definitely research out there, although none at first glance that have done a full scale comparison between countries (actually, mybe this is a start? pdf link, sorry). If you start looking through those searches you should be able to come up with some better search terms and start to narrow it down. I think that using the more specific journal search engines should help with your OMG ViAGRA! problems earlier. There's even a journal called PharmacoEconomics which sounds like the right area, so maybe that's something to look at or a search term to use, and other.

Reading through a couple it looks like the OTC switch has at least the potential to increase costs to patients in the UK (ref) but because of your system in the USA it may make it cheaper (ref), and overall it's kind of a messy question. As I already mentioned OTC is more expensive in NZ since it's not regulated or subsidised like prescription, so here at least making things OTC moves the cost from the government onto the patient.
posted by shelleycat at 10:03 PM on September 18