No doctor visit needed for some rx meds?

[portlandia]

FDA wants to allow some rx medications to be available without first seeing a doctor.

 

https://www.bloombergquint.com/business/2018/07/17/u-s-to-make-more-drugs-easily-available-cutting-role-docs-play

 

Thoughts?

 

[Hatton]

Seems wrong.  In my field I see a problem with cigarette smokers over 35 continuing to take OCPs if they were OTC.

[NaOH]

The idea of giving pharmacists prescriptive authority, or creating a third 'behind the counter' class as this article mentions, gets batted around occasionally. I'm of two minds about it - on one hand, I can certainly see some situations where it makes sense to give us the ability to renew maintenance meds, or provide things like rescue inhalers, etc. On the other, I'm not so naive as to think our patient assessment skills are anywhere close to those of a physician, or even a PA/APRN - it just isn't what we're trained to do. If you're unwell enough to need prescription meds, you're unwell enough to need regular contact with an actual PCP.

 

The cynic in me objects because this would be just another metric that our corporate retail pharmacy overlords would hold us accountable for while not actually paying us any more.  :roll:

[Anne]

1.  Very doubtful that this would do much to lower healthcare costs.

2.  Who is going to be expected to answer the questions (probably via phone call, for free) about the medications/side effects when they arise and manage the ensuing complications that arise, and get blamed for unfavorable outcomes when the complications aren't identified in time to make a difference because nobody was monitoring?  The drug companies?  The FDA?  Umm, no...that would be us.

[Peds]

hatton1 wrote:

Seems wrong.  In my field I see a problem with cigarette smokers over 35 continuing to take OCPs if they were OTC.

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Isn't the risk still less than complications of pregnancy?

[burritos]

I vote go for it.

[Zaphod]

Lots of things go OTC, allegra and nexium for example, and it seems like for the most part we dont hear about too much trouble from it. May just be lost in the noise though. It would be great not to have to go through a rigamarole for all kinds of no abuse, easy to use, low side effect, low risk type meds and make them basically otc. Would take a lot of work from each specialty to identify a list but could be amazing and decrease those visits that are basically rx signing visits.

Will be hard to thread the trouble/ease needle, but if anything, it really makes things easier. I cant say how happy I am that allegra, nasal steroid sprays and differin are now otc. Makes life much simpler. Having to go through the pcp, get a referral, wait forever, for basically a quick sign off with all the associated costs is crazy. Would actually be great if a task force identified many candidates in all fields with an eye towards decreasing well rx visits and friction, but thats a utopian type vision Im sure. It will be haphazard and illogical if it happens.

[ENT Doc]

The cynic in me wonders who is pushing for this. Because I doubt they're the slightest bit interested in reducing healthcare costs.

[burritos]

ENT Doc wrote:

The cynic in me wonders who is pushing for this. Because I doubt they’re the slightest bit interested in reducing healthcare costs.

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Insurances companies win cause they don't have to cover these OTCs. Pharma wins cause they get to sell more product. Doctors win/lose cause they have to deal with less scutwork/get less revenue. Patients win/lose cause they don't have to see-pay a doctor/but now have no generic coverage from insurance.

[LizOB]

Peds wrote:

hatton1 wrote:

Seems wrong.  In my field I see a problem with cigarette smokers over 35 continuing to take OCPs if they were OTC.

Click to expand…

Isn’t the risk still less than complications of pregnancy?

Click to expand...

Not in a smoker over age 35.

I have mixed feelings about OCPs being OTC. Generally probably not a good idea, however there is the occasional upset patient for whom I refuse to refill the rx due to a contraindication who would be able to just get them herself, without any liability on my end...

[stellardoc1]

I vote for it.

I think regular people should be able to get a hold of simple medications without seeing a physician. They should be even able to get some OTC abx such as azithromycin etc. Will decrease ER/urgent care visits for simple unnecessary things. We know ASA causes bleeding but still available OTC.

OCPs should be available OTC as well. No need for prescription. If complications happen, happen. The patient should be fully liable for it. In that case they will come to ED or go to PCP if less severe.

Getting regular medications OTC is a common thing in many countries (mostly third world) but also many developed countries. This will take the burden away from PCPs. Anyways, most PCPs are hard to get to regardless (atleast in my area).

 

[CordMcNally]

stellardoc1 wrote:

They should be even able to get some OTC abx such as azithromycin etc. Will decrease ER/urgent care visits for simple unnecessary things.

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I disagree fairly strongly with this. The layperson doesn't even understand exactly what an antibiotic will treat let alone when they really need one. I don't think it'll reduce ER/urgent care visits. We'll just see a lot more of the "I'm already on xyz antibiotic and I'm not getting better" people. I'm a firm supporter of using antibiotics appropriately even if it gives me a bad Press Ganey.

[docnews]

Zofran should be OTC in my humble opinion. Symptom based medicines should but not antibiotics.

[NaOH]

docnews wrote:

Zofran should be OTC in my humble opinion.

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My favorite med, ever. Stuff's magical.

[StarTrekDoc]

Some are pretty clear lines where as a physician I would never deny and a pharmacist can rx:

Epipen and naloxone are slam dunks.  Even statins are pretty clear cut and behind-the-counter makes sense.  Linear usage and actions with minimal monitoring and guidances at lower dosing.

Plan B is a good example already working well.

These are visits that will all eventually disappear anyways with minute clinics growth IMHO