Why would my doctor prescribe me something I can buy over the counter?
September 13, 2015 8:51 PM Subscribe
My doctor prescribed me regular ol' Tylenol--couldn't he have just recommended that I take my preferred OTC pain reliever?
I recently went to urgent care for a nasty case of swimmer's ear. The doctor sent me on my way with two prescriptions--one for ear drops to knock out the infection, and one for 500 mg Tylenol for the pain (just regular Tylenol, no codeine or anything).
I didn't really think about it until now but a quick Google search tells me there is zero difference between prescription and OTC acetaminophen (Tylenol) other than dosage, but then doesn't it just come down to how many pills you are taking (e.g. five OTC 200 mg = two RX 500 mg)? A little annoyed that I spent $20 on a prescription for something I essentially already had at home. Not a big deal--just curious as to how the prescription process works (so maybe next time I can just tell the pharmacy not to bother filling something like that).
I recently went to urgent care for a nasty case of swimmer's ear. The doctor sent me on my way with two prescriptions--one for ear drops to knock out the infection, and one for 500 mg Tylenol for the pain (just regular Tylenol, no codeine or anything).
I didn't really think about it until now but a quick Google search tells me there is zero difference between prescription and OTC acetaminophen (Tylenol) other than dosage, but then doesn't it just come down to how many pills you are taking (e.g. five OTC 200 mg = two RX 500 mg)? A little annoyed that I spent $20 on a prescription for something I essentially already had at home. Not a big deal--just curious as to how the prescription process works (so maybe next time I can just tell the pharmacy not to bother filling something like that).
I've had prescriptions for Ibuprofen that have been 4 times as strong and much cheaper than OTC, 30/ 800 mg for $5.00 copay.
posted by Linnee at 9:03 PM on September 13, 2015
posted by Linnee at 9:03 PM on September 13, 2015
It's usually cheaper to get something through a RX with your insurance, especially if they can sub a generic. You can also always ask how much it is and refuse to buy it from the pharmacy even after they fill it. They can't force you to take or pay for your prescription. (Also I'm confused - was $20 just for the Tylenol or also including the ear meds? You should have a per med rundown on the receipt.) And for the future, you can ask the pharmacist too before paying - especially if it'd be hard to get ahold of the walk-in doctor. They're usually super helpful.
My generic omeprazole (Prilosec) is $3 a month with my RX and insurance versus paying at least $15 a month even for the store brand OTC.
posted by Crystalinne at 9:03 PM on September 13, 2015 [1 favorite]
My generic omeprazole (Prilosec) is $3 a month with my RX and insurance versus paying at least $15 a month even for the store brand OTC.
posted by Crystalinne at 9:03 PM on September 13, 2015 [1 favorite]
Response by poster: I *thought* the Tylenol was $20 (the total was definitely more than that and I know the ear drops were even more expensive) but I could be wrong (and I've since tossed the receipt). The "doctor figured it would be cheaper with a prescription" explanation is probably the most likely. Thanks all. :)
posted by lovableiago at 9:07 PM on September 13, 2015
posted by lovableiago at 9:07 PM on September 13, 2015
He may also be covering his own ass, professionally. By prescribing Tylenol at a higher dosage than OTC, he's creating a paper trail with precise instructions, vs merely advising you to take a higher dosage than indicated on the bottle.
posted by SobaFett at 9:13 PM on September 13, 2015 [7 favorites]
posted by SobaFett at 9:13 PM on September 13, 2015 [7 favorites]
Yeah, he's giving you precise instructions and exerting control over the situation, as opposed to saying "just take some Tylenol."
Also, pill strength is something that is behaviorally designed. Believe it or not, the dosage in OTC pills is often set to be sufficient if you take two pills. Of course, they could pack the pills more strongly and you'd just take one pill, but behavioral study has shown that people just feel one OTC pill isn't enough, since "it can't be that strong!", and will take two, regardless of strength - which puts them at risk. Most people aren't paying attention to milligrams of active ingredient. If you're getting extra-strength via the pharmacist, that may be enough to psychologically convince you that one pill is enough.
posted by Miko at 9:43 PM on September 13, 2015 [1 favorite]
Also, pill strength is something that is behaviorally designed. Believe it or not, the dosage in OTC pills is often set to be sufficient if you take two pills. Of course, they could pack the pills more strongly and you'd just take one pill, but behavioral study has shown that people just feel one OTC pill isn't enough, since "it can't be that strong!", and will take two, regardless of strength - which puts them at risk. Most people aren't paying attention to milligrams of active ingredient. If you're getting extra-strength via the pharmacist, that may be enough to psychologically convince you that one pill is enough.
posted by Miko at 9:43 PM on September 13, 2015 [1 favorite]
My doctor wrote me a prescription for low-dose aspirin a few years ago, which I left at the pharmacy in favor of the ultra-cheap Costco stuff (two years' worth for some stupid cheap price) that I had already been taking. When at my next visit I told him what I had done, he said that was fine; he had written a prescription so that it would be in my record. So when I see him now, he asks if I'm still taking the aspirin, and I say yes.
posted by pmurray63 at 9:51 PM on September 13, 2015 [1 favorite]
posted by pmurray63 at 9:51 PM on September 13, 2015 [1 favorite]
My doctor prescribed me Ranitidine, which is OTC Zantac. I asked him why the prescription and he said "well you can't very well blue cross it if it's not a prescription, can you" so there's that as well.
posted by Sternmeyer at 10:40 PM on September 13, 2015
posted by Sternmeyer at 10:40 PM on September 13, 2015
Best answer: I am a doctor who writes acetaminophen and ibuprofen and other OTC meds as prescriptions. I mainly do it because I know some insurances will cover it that way. Nothing to do with covering my ass - I could easily document instructions with recommended dosage and frequency in the discharge instructions without writing a script. I think you got a bad pharmacist. Usually a pharmacist should pick up on it if you"re paying too much for a med so you could either get the RX changed or in this case, just buy it generic and OTC.
posted by treehorn+bunny at 12:11 AM on September 14, 2015 [8 favorites]
posted by treehorn+bunny at 12:11 AM on September 14, 2015 [8 favorites]
Also, you mentioned Tylenol vs your preferred OTC pain reliever. It's possible in the case the doc thought acetaminophen (Tylenol) would be more effective than whatever your choice may have been, ie ibuprofen (Advil) or others.
posted by cgg at 3:56 AM on September 14, 2015 [2 favorites]
posted by cgg at 3:56 AM on September 14, 2015 [2 favorites]
She is telling you how much to take, how to take it (orally), how often, and for how long, not where to buy it.
Just be careful splitting pills in the case that you need 2.5 of the cheaper pill. There are many pills where the medicine is not evenly distributed through the pill, so if you split pills you can end up with an over dose and an under dose. Other pills (slow release, etc.) rely on being swallowed unbroken to work in the intended way, if you split them then this doesn't work. You can look up if certain pills are safe to split, or you can find a different formulation where you can take a whole number of the substitute pills, or something like a liquid where you can measure an exact dose. (Unless your prescription says "as needed", in which case you can round down as long as it is adequately filling your needs, i.e. reducing your pain.)
posted by anaelith at 6:07 AM on September 14, 2015
Just be careful splitting pills in the case that you need 2.5 of the cheaper pill. There are many pills where the medicine is not evenly distributed through the pill, so if you split pills you can end up with an over dose and an under dose. Other pills (slow release, etc.) rely on being swallowed unbroken to work in the intended way, if you split them then this doesn't work. You can look up if certain pills are safe to split, or you can find a different formulation where you can take a whole number of the substitute pills, or something like a liquid where you can measure an exact dose. (Unless your prescription says "as needed", in which case you can round down as long as it is adequately filling your needs, i.e. reducing your pain.)
posted by anaelith at 6:07 AM on September 14, 2015
Anaelith made a point I wanted to make — some Rx pills are slow-release. After a running injury, my doc prescribed Etodalac for me to take once a day versus having to take an OTC Naproxen every 4-6 hours.
posted by Brittanie at 6:15 AM on September 14, 2015
posted by Brittanie at 6:15 AM on September 14, 2015
In my health care organization, prescriptions get entered into a patient's electronic medication list. So the doctors will enter even vitamin supplements that a patient is taking so as to have accurate documentation of what the patient is using.
posted by SLC Mom at 8:01 AM on September 14, 2015 [1 favorite]
posted by SLC Mom at 8:01 AM on September 14, 2015 [1 favorite]
Nthing 'so it's in your file'. Tylenol is something you can easily OD on, so if you see another doctor for any reason they know not to prescribe more.
posted by sexyrobot at 9:19 AM on September 14, 2015
posted by sexyrobot at 9:19 AM on September 14, 2015
1) some insurances will cover OTC meds if there is a prescription--Medicaid usually does, for instance--or have allowances for OTC meds as a benefit.
2) Your doctor is required under certain federal programs to keep a list of your OTC medications in addition to prescriptions and the easiest way to do this is to write it as a prescription. Sometimes in the process of trying to get everything documented these get sent in accidentally even if the doctor didn't actually mean to, because it's an extra step to not send the Rx.
This is a downside of the switch to electronic prescribing--if you were going in with a paper prescription usually your pharmacist would just look at it and say "Oh, that's over the counter--Aisle 10" but with the switch to electronic usually the Rx is waiting for you at the pharmacy.
posted by The Elusive Architeuthis at 10:05 AM on September 14, 2015
2) Your doctor is required under certain federal programs to keep a list of your OTC medications in addition to prescriptions and the easiest way to do this is to write it as a prescription. Sometimes in the process of trying to get everything documented these get sent in accidentally even if the doctor didn't actually mean to, because it's an extra step to not send the Rx.
This is a downside of the switch to electronic prescribing--if you were going in with a paper prescription usually your pharmacist would just look at it and say "Oh, that's over the counter--Aisle 10" but with the switch to electronic usually the Rx is waiting for you at the pharmacy.
posted by The Elusive Architeuthis at 10:05 AM on September 14, 2015
Aside from the points about regular insurance, Flex spending will often pay for normally-OTC items if you have a prescription. I've saved a lot of money on Allegra over the years thanks to that.
posted by kythuen at 10:29 AM on September 14, 2015 [1 favorite]
posted by kythuen at 10:29 AM on September 14, 2015 [1 favorite]
Just so you know if you're ever doing substitutions/conversions in the future, the standard over the counter "regular strength" Tylenol is 325 mg per pill, not 200. It is very easy to accidentally overdose on Tylenol, and unlike a lot of other OTC meds (e.g. ibuprofen), the consequences go from non existent to severe in the span of a small number of pills. Aim for no more than 3 g per day and remember that means nine regular strength pills, not 15.
posted by telegraph at 2:43 PM on September 14, 2015 [1 favorite]
posted by telegraph at 2:43 PM on September 14, 2015 [1 favorite]
This thread is closed to new comments.
posted by right_then at 8:55 PM on September 13, 2015 [13 favorites]