There’s a swirl of myths out there — floating around about how prescription drugs…that once they go over the counter (OTC)…might be considered “basic,” “safe,” “lower cost,” and “easy to access.”
I want to discuss this today — because there’s a LOT of myth-busting that we in pharmacy need to do around this topic, long overdue. It’s been brewing in my head for a while now.
DISCLAIMER: The opinions I’m about to share are my own — as a pharmacist for over 20 years. Please do not consider any of this medical or pharmacy advice specific to your situation. Instead, take it with a grain of salt and talk to your own pharmacist or healthcare provider and ask questions about all the drugs that they recommend for you — even the OTC drugs. The goal of this article is to remind all of us to respect the power, cost, and even the potential danger behind any drugs that we put into our bodies — including OTC drugs.
Okay — onward post disclaimers. Here are 4 common myths around OTC drugs I’ve witnessed over the course of my career that’s it time to bust:
Mythbusting on OTCs
- MYTH #1: OTC DRUGS ARE SAFE, or SAFER THAN THEIR RX COUNTERPARTS. First, ANY and ALL drugs SHOULD be considered dangerous and/or hazardous to humans and animals. Just because it happens to finally go over the counter or OTC does not make the drug necessarily any safer or reduce the potential for harm in any way. Let me give you two examples of drugs that have gone OTC but still to this day have safety issues that are not insignificant: 1. Acetaminophen at high doses can be toxic and can damage your liver. Overdose can cause death. 2. Ibuprofen actually had black box warnings on increased blood clots, heart attacks, strokes, and GI bleeds in its package insert, or the instructions and information that the FDA approves on a drug that’s cleared for use in humans.
I don’t want to scare anyone here — but I want to bust the myth that once the drug is OTC, it’s completely safe at any dose and without any regard for the directions that come with the drug.
✅ THE TRUTH: Drugs OTC are not necessarily any safer than their prescription drug counterparts — they still should be used according to instructions and not abused.
2. MYTH #2: IF MY DOCTOR WRITES A PRESCRIPTION FOR AN OTC, IT SHOULD BE SUPER FAST AND EASY FOR A PHARMACIST TO FILL. Recently and literally, I saw someone call one of the pain relievers above a “basic AF” drug and they could not understand why it was taking so long to fill at their pharmacy after their doctor wrote a prescription for it. I’m not sure if the patient assumed that because it was OTC pharmacists just slap a label on the bottle and hand it over to the patient?
I’m here to say that is definitely not the case.
It takes just as long to fill an OTC drug your doctor writes a prescription for you, as any prescription/legend/or dangerous drug, if the pharmacist is doing their job correctly. The pharmacist — no matter whether the drug is — OTC or prescription — is going to check the dose of the drug for the patient prescribed, check for drug-drug interactions with medications the patient is currently taking, and look out for anything else that might cause the patient harm — like drug allergies. It doesn’t matter if the drug is OTC. The drug once it goes OTC does not become safer per myth #1 above.
✅ THE TRUTH: OTC Prescriptions from your doctor aren’t going to be filled any faster. They are treated just like all prescription/legend/dangerous drugs in your pharmacy.
3. MYTH #3: ONCE A DRUG GOES OVER THE COUNTER, IT’S CHEAPER THAN THE PRESCRIPTION VERSION. This is actually my favorite OTC myth to bust, because it’s not always true. In fact, it’s RARELY true. The classic example here to use is omeprazole (brand name Prilosec or Prilosec OTC). The Brand name of the prescription formulation is Prilosec, and it comes in capsules. The OTC name is Prilosec OTC, and it comes as tablets. Here’s a little analysis I did of price on the OTC tablet version vs. the prescription capsule version last fall, same strength or dose:
On the left side of the table above, I looked at pricing at 5 pharmacies — 3 were retail pharmacies, and 2 were mail-order or online pharmacies. First, I reviewed the OTC brand and generic costs. The Brand Prilosec OTC 20 mg tablets’ average cost per tablet across these 5 pharmacies was $0.64/tab. Then, I looked at the OTC generic formulation — costs there on average were around $0.50 per tablet.
Last, I looked at the prescription-only formulation of omeprazole 20 mg capsules. What was the average cost per capsule? 34 cents. That’s HALF of the brand average OTC!
Now, to be fair, this analysis does not include any dispensing fees — it’s strictly an ingredient cost analysis. However, it’s an important one, because when you compare ingredient costs, they’re radically different…and most important, the prescription version is just flat-out cheaper.
✅ THE TRUTH: Once a drug goes over the counter, it’s not necessarily cheaper. In fact, it could be (a lot) more expensive. Shop around and talk to your doctor and pharmacist.
4. MYTH #4: ONCE A DRUG GOES OVER THE COUNTER, IT’S EASIER TO ACCESS. Spring is nearly around the corner — allergy time. Toss a head cold on top of it, and many people may be looking for antihistamine-decongestant combination drugs out there to treat their symptoms. However, decongestant drugs — while OTC — are not the easiest drugs to access, thanks to the Combat Methamphetamine Epidemic Act of 2005 (CMEA). This law was put into place, along with an entirely new process and system — to purchase pseudoephedrine in pharmacies, because it was being used to make methamphetamines.
While no doubt meth can ruin lives and devastate communities, there was an entirely new system (which you can read about in my own home state of Indiana here, as one state’s example of compliance with this law) just so people can purchase it OTC. If you look at the regulations, methinks it might just be easier to go ahead and get that prescription — on everyone — patients and pharmacies included here.
My point with pseudoephedrine is, it’s not really that much easier to get access to as an OTC drug than it would be as a prescription. I think in many cases if you need more quantity of the drug, it might actually be easier to get it with a prescription.
Last, I’ll leave you with this: there are some drugs that are OTC that your prescription benefits plan might be obligated to cover at $0 for you. It’s a list of drugs from the Affordable Care Act, and they’re for the prevention of some health issues. Your plan should have a list of the ACA preventative drugs covered at $0. Ask your HR person or plan administrator for a list of those drugs, and get a script for them rather than paying out of pocket your hard-earned money. Otherwise — why have pharmacy benefits in the first place? This point not only plays into access but cost as well — see above on #3.
✅ THE TRUTH: You might want to discuss this with your doctor and get a prescription for your OTC drug, rather than just buying it over the counter. Access isn’t always super easy OTC.
There. Four huge myths busted when it comes to OTC drugs. Please consider these when you’re meeting with your doctor at your annual check-up — OTCs are just as important and vital as their prescription drug counterparts, and they deserve the same caution, respect, and care for patients as prescription (Rx) drugs. OTCs, and all drugs — are not widgets — they can be dangerous, and conversely life-saving. You want your pharmacist taking care of you and your family, and watching out for your safety — no matter what status the drug is.
Hope these help you make better and more economical decisions for your own care, and your family’s care too. Thanks for reading.
Erin L. Albert is a pharmacist and VP of Pharmacy Relations at Mark Cuban Cost Plus Drug Company, PBC. Opinions above, however, are her own. Opinions also should not be construed as medical or legal advice — please seek counsel in your own jurisdiction for your own care and advice from a licensed provider.