Debate over shifting drugs to OTC

The money saved by making drugs such as oral contraceptives available OTC would not be worth the risk, doctors say

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The money saved by making drugs such as proton pump inhibitors and oral contraceptives available over the counter would not be worth the risk, leading Australian doctors say.

Their comments follow a Canadian report showing $1 billion (AU$983 million) could be shaved off the health budget every year by making erectile dysfunction drugs, oral contraceptives and PPIs available OTC.

As Australia’s economy and regulatory environment is quite similar to Canada, comparable savings could be made here, the Australian Self-Medication Industry claimed.

The industry lobby group said the Canadian report lends support its ‘switch agenda’, which calls for more prescription-only drugs to be made available OTC.

Most of the economic gains would be made from PPIs going OTC, with oral contraceptives creating around $200 million in savings and ED drugs freeing up around $100 million in the Canadian health budget, the report said.

“For each drug class, substantial economic benefit would result from increased efficiency and productivity gains due to fewer primary care visits,” the report, created by The Conference Board of Canada, said.

However, both the AMA and the RACGP were quick to criticise the proposal, arguing that taking GPs out of the equation was false economy.

Dr Bastian Seidel, RACGP’s president, said focusing on a perceived cost alone did not do the doctor-patient relationship justice. Patients on these medications needed proper evaluation and regular monitoring.

“Health is not a commodity that can be negotiated between a willing seller and the highest bidder,” he said.

The issue with making oral contraceptives available OTC is two-fold, explained Danielle Mazza, a professor of general practice at Monash University.

Firstly, it takes away the opportunity for GPs to assess the suitability of ‘the pill’, check for contraindications and suggest alternatives, such as long acting reversible contraceptives.

And, secondly, GPs often use consultations for repeat prescriptions as an opportunity to improve their patients’ health literacy in other areas, such as cancer screening and STIs.

However, Professor Mazza said there were some benefits from making oral contraceptives available OTC, including increased accessibility. “It is easier to get to a chemist than a doctor,” she said.

A US study published last week in the Journal of Adolescent Health found that OTC availability reduced the barriers to contraceptives and could further reduce unintended pregnancy rates, particularly in adolescents.

Professor Mazza said that while she still had concerns, the idea was worth exploring in the Australian context.

Making ED drugs available OTC was associated with risks such as missed diagnoses, said Dr Seidel.

“Erectile dysfunction could well be a symptoms of a more severe underlying medical condition such as diabetes mellitus or PVD,” he said.

“This needs to be assessed before initiating symptomatic treatment. Clearly, it would be in everybody’s interest to treat the underlying cause.”

And PPIs also needed to be used carefully and judiciously, Dr Michael Gannon, AMA’s president, said.

“Some patients should have a gastroscopy from time to time to make sure that there is no disease progression,” he said.

“This is part of what GPs and doctors do every day – to keep an eye on these conditions, recognise the risk of long-term medication use, recognise new advancements and new medicines … and take health promotion opportunities in other areas.”

“There are always groups that seek to nibble at the sides of what GPs do,” he added.

“It’s not the first time we’ve heard these calls and it again shows an inability to understand the complexity of medical practice and the need to treat prescription of these drugs carefully.”