The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Over-the-counter”

More drugs on OTC status would mean more costs for Medicare beneficiaries

The FDA is considering making more medications available over the counter.

Imagine being able to get your high blood pressure pills, diabetes medications, or asthma inhalers over the counter without a prescription from your doctor. All you would need to do, at most, is have a brief discussion with the pharmacist to make sure you know how to take the medication the right way. You would never have to worry about running out of pills on a weekend or having to get a new prescription when your refills run out.

Sounds pretty good, right? Don’t say yes to fast. Allow me to explain.

A few weeks ago, the Food and Drug Administration (FDA)  told a group of health reporters that it was thinking about moving some commonly prescribed medications to over-the-counter (OTC) status. Some of the medications the FDA is considering switching include drugs to treat such chronic conditions as diabetes, migraines, asthma, high cholesterol, and high blood pressure.

According to an article published in Pharma Times last week, the FDA proposal states that making these drugs available OTC  would reduce the number of routine doctor visits and thus “could free up prescribers to spend time with more seriously-ill patients, reduce the burdens on the already-overburdened health care system and reduce health care costs.”

I’ve highlighted that last part for a reason: Yes, making more drugs available over the counter would reduce costs — for employers, health insurance companies, and government programs that provide prescription drugs for beneficiaries. In other words, Medicare and Part D plans will save a lot of money if some of these common drugs get OTC status.  But you’ll have to pay a lot more. OTC drugs are not covered by Medicare, which means you will have to pay the full cost of your medications instead of a small co-payment.

As John LaMattina notes in Forbes, if the FDA does allow these medications to become available over the counter, “billions of dollars in prescription drugs costs would get shifted from the current payers to the consumer.”

I’m not even going to talk about the safety issues here – that’s a completely different subject that also needs to be addressed. But let’s think this through. Suppose you have high blood pressure and take just two medications to keep it under control. Right now these drugs are covered by Medicare Part D, so it’s worth it to pay the monthly premium for your Part D plan because you’re saving hundreds of dollars a year with the coverage.

Now let’s say the FDA decides it ’s safe to make your two medications available over the counter. Will it still be worth paying a monthly premium of $30 to $75  for a Med D plan if you have to pay 100 percent out of pocket for your drugs? Probably not. But Medicare has you there, too, because if you disenroll from your plan and go without coverage for 63 or more consecutive days, you’ll have to pay a late enrollment penalty if and when you decide to join a plan again.

 Let’s hope the powers that be also think this through before taking any action. What do you think?

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