Governments in several countries with public Pharmacare and in a few provinces in Canada are considering reclassifying some drugs from prescription to over-the-counter status. In a Canadian Medical Association Journal essay, Lynd and colleagues comment on the economic effects of such changes.
The drugs being considered are used in a wide variety of chronic diseases. They include proton pump inhibitors, beta-blockers, diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, HMG CoA reductase inhibitors, inhaled corticosteroids, short and long-acting B2 agonists, bisphosphonates and oral contraceptives. In the UK, 100 drugs are on the Medicines Control Agency's short-list for conversion to over-the-counter status. In Ontario, 8 of these drugs account for $540 million (27%) of the Ontario Drug Benefit Plan budget. In BC, 49 of these drugs account for $266 million (44%) of total Pharmacare drug expenditures.
Delisting drugs from public health insurance programs transfers the costs of the drugs to private citizens or to their private health insurance plans. In addition to cost-savings to government programs these changes are being driven by pharmaceutical companies who can expect larger markets and increased sales. There may also be economic benefits to pharmacists who while losing prescription drug revenue would gain in volume of over-the-counter sales. Also, if the drugs were regulated to behind-the-counter status (No Public Access), pharmacists would not just dispense medications, they would have a clinical and consultative role. Visits to physicians for routine control of chronic diseases might also decline.