Rx-TO-OTC SWITCH COST SAVINGS IN U.K.

Rx-TO-OTC SWITCH COST SAVINGS IN U.K. may be related more to reductions in physician workload than to product pricing and reimbursement savings, according to an editorial in the June 4 issue of The Lancet. Asserting that the "bigger potential saving is in general practitioner's time," the editorial points to a survey conducted by the Proprietary Association of Great Britain (PAGB) that estimated that "appropriate self-meditation with an OTC drag would reduce general practitioner's workload by 16 consultations a day."

The editorial also cited another PAGB estimate that "100-150 mil. general practice consultations per year are for conditions that are potentially self-treatable." However, the editorial points out that "general practitioners may be reluctant to give up their patients to pharmacists" given that "only 51% [of doctors] in the PAGB survey had no concerns about a patient going to a pharmacist for advice."

When looking at cost savings arising from products switching to OTC status, the editorial notes that a U.K. "fundholding practice" calculated that for a group of "common drugs that might be recommended for OTC purchase, the annual cost would be (BRITISH POUND)2,000 to the [National Health Service] or (BRITISH POUND)15,000 if the drugs were bought OTC,"

Based on the size of the fundholding practice, the editorial concludes that the savings would not be "significant." In addition, the editorial notes that the calculation assumed "that all the patients would switch to OTC, which is very unlikely."

The editorial points out that general practitioners in the U.K. can currently recommend that a patient purchase an OTC product instead of paying for the same item under a prescription, "but few doctors may do so because it takes a longer consultation to explain about the OTC status, check that the OTC price is less than the current prescription cost (and package differences can be difficult to reconcile), and check whether the patient is exempt from prescription charges anyway." Although many OTCs are "considerably cheaper" than their prescription counterparts, the editorial adds, "about 80% of prescription items are dispensed free."

Shifting more drags to OTC status, the editorial says more generally, "is positive, yet highlights the need for major education of the public, pharmacists, and pharmacy-counter assistants." This could include "drug information leaflets in plain language for lay people" and "further education for pharmacists and their assistants, which must include training in interpersonal skills," the editorial states. The pharmacist "may well need to spend more time at the front of the shop rather than hidden in the dispensary" to advise consumers on side effects, drug interactions and the persistence of symptoms.

"Touch-sensitive help-screens for customers and protocols/algorithms and memo-cards for advisers in pharmacies are ideas for the future," the editorial suggests. Side-effect monitoring should also be a "top priority" with Rx-to-OTC switch products, the editorial adds, noting that in the U.K. only doctors can report adverse drug reactions. "At the least, pharmacists must be included here," the editorial advises.