Jeffrey A. Singer
Today President Trump announced he will ask Congress to enact what he calls “The Great Healthcare Plan.” The proposal is light on details, but one item on the White House fact sheet jumped out at me: making more proven, safe drugs available over the counter. From the fact sheet:
Allow More Over-the-Counter Medicines
Make more verified safe pharmaceutical drugs available for over-the-counter purchase. This will lower healthcare costs and increase consumer choice by strengthening price transparency, increasing competition, and reducing the need for costly and time-consuming doctor’s visits.
If President Trump succeeds, then reclassifying many prescription-only pharmaceuticals as over the counter should indeed help lower drug prices. As Michael F. Cannon and I explained in our Cato White Paper, “Drug Reformation,” moving a medication from prescription-only to over-the-counter almost always puts downward pressure on its price. When the heartburn drug omeprazole made that switch, the cost of a day’s dose dropped from about $4.20 to roughly $2.35. The allergy drug loratadine experienced a similar decline, with the price falling to around a dollar a pill. In many cases, once drugs are sold over the counter, their sticker price ends up lower than what insured patients used to pay in copays. Experience shows that when the Food and Drug Administration (FDA) reclassifies pharmaceuticals from prescription-only to over-the-counter, patients comparison shop, and prices tend to drop. A second, distinct benefit, as bioethicist Jessica Flanigan notes, is that prescription mandates can lead patients to depend more on doctors’ authority rather than understanding their own medicines, while easier, over-the-counter access could promote more active patient involvement and research.
For many years, I have urged the FDA to remove barriers preventing women from accessing birth control pills and other hormonal contraceptives over the counter, just as women in more than 100 other countries do—along with the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Medical Association. Two years ago, the FDA finally removed barriers to one brand of one type of birth control pill—the progestin-only pill or “minipill.” This was a mini-step in the right direction. Now it’s time to eliminate barriers to the other forms of hormonal contraception.
The FDA should also remove obstacles to over-the-counter HIV pre- and post-exposure prophylaxis (PrEP and PEP), so people can access them through vending machines.
As I have written here, GLP-1s are good examples of drugs people should be able to purchase over the counter. Aside from their effectiveness in helping people overcome obesity and its accompanying complications, they may also turn out to be a useful tool for people with nascent or established substance use disorders to manage cravings and compulsive behaviors—without the stigma and barriers that often accompany seeking formal treatment.
Policymakers might argue that adults could misuse these drugs if they can buy them over the counter. However, we already trust people with many over-the-counter medications that can be deadly if misused. Acetaminophen can cause fatal liver failure in overdose. Aspirin can trigger life-threatening metabolic issues. Large doses of diphenhydramine (Benadryl) can lead to lethal heart rhythm problems, and even common NSAIDs (e.g., ibuprofen and naproxen) can cause kidney failure, seizures, and more. Still, we don’t respond to these risks by requiring prescriptions; instead, we rely on labels, warnings, and the fact that most people don’t want to poison themselves. The potential for harm has never been a valid reason to treat adults as if they can’t make their own choices.
If the president and Congress follow through on the promise to shift more prescription drugs to pharmacies’ over-the-counter sections, they will make medicines cheaper and more accessible—but, more importantly, they will return a measure of control over health care to patients themselves, where it belongs.