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FDA May Let Patients Buy More Drugs Without Prescriptions
Hugh Pickens writes "The Washington Times reports that the Food and Drug Administration may soon permit Americans to obtain some drugs used to treat conditions such as high blood pressure and diabetes without obtaining a prescription. They may allow patients to diagnose their ailments by answering questions online or at a pharmacy kiosk in order to buy current prescription-only drugs for conditions such as high cholesterol, certain infections, migraine headaches, asthma or allergies. Some pharmacists embrace the notion that they should be able to dole out medication for patients' chronic conditions without making them go through a doctor. 'This could eliminate the need for a physician visit for certain meds that may have been prescription prior to this change,' said Ronna Hauser, vice president of policy and regulatory affairs for the National Community Pharmacists Association. 'However, there may be circumstances when a patient might need a physician visit and diagnosis and original prescription to start therapy but could continue on that therapy with pharmacist refill authorization capabilities.'" (Read more, below.)
Hugh Pickens continues: "Medical providers at public hearings to obtain input on a new paradigm urge caution, saying the government should not try to cut health care costs by cutting out doctors. 'Patients rely on physicians to provide sound diagnosis and treatment information and to help them meet their unique health needs,' says Peter W. Carmel, President of the American Medical Association. 'Expanding many prescription medications to OTC interferes with that important relationship without offering any real benefits to improve patients' health or reduce their costs.'" Other countries seem to do fine with pharmacists being closer to the front line of medicine recommendations; why couldn't the U.S.?"
I'm pretty sure the American Medical Association (made up of doctors) is going to go apeshit over even the suggestion of this.
What political party do you join when you don't like Bible-thumpers *or* hippies?
I am hugely thrilled at this prospect. It would mean that I can have more respect for my doctor, rather than looking at her as a person with a magic signature. For the past several years I have been going to a "Minute Clinic" which is a nurse-operated room, in which the nurse takes my vitals, reads questions off a computer screen and enters the answers, and then gives me a prescription. There is definitely room for medical judgment there, but mostly that judgment is used to send you to a doctor if the computer tells the nurse to do so. There's no reason for me to need to see a person for many types of illnesses when a questionnaire can suffice - no reason other than institutional inertia.
My mom used to tell me about the old days when you asked the pharmacist for medicine - told them what your problem was and they would give you the cure. There's another profession rooted in the old ways for no good reason. The pharmacy takes pills out of one container, counts them, puts them into another container, and sticks a label on it and bills my insurance. Takes 15 minutes and requires a highly trained pharmacist for reasons I cannot fathom.
I have a hard time believing people go into primary care medicine (or pharmacy, for that matter) to see jerks like me, who just want a piece of paper that says I can have my pills. Seems like this could be a benefit for all.
... are re-classified as no longer needing to be prescribed, insurance companies stop covering the cost of such drugs. Lots of expensive drugs (for allergies, for gatrointestinal problems) once covered by insurance are now totally NOT covered. A big win for insurance companies.
Credo quia impossibilis -- Tertullian
I just want to thank the FDA for allowing me to pee without permission.
Seastead this.
A few of my acquaintances are pharmacists, and one of their biggest contributions to the overall health and care of patients is drug interaction and reconciliation. Basically, what this means is that they check that a patient's drugs do not interact with each other in a negative way. They also help patients reduce the number of dependencies on medication. When you start to automate this process, you will need to have a centralized system that handles all patients' drug information as you have now removed the role of various trained medical professionals. A patient will not know that his need for a prescriptive drug may adversely affect his health because he is already taking another drug. That's sort of why we have pharmacists and doctors.
TFA mentions the impact on Medicare for prescription drug costs, but it doesn't discuss the impact for non-seniors. My prescription drug plan doesn't cover over-the-counter medication. As of last year my flex pay plan won't let me buy over-the-counter medication with pre-tax dollars. Together, both of those mean that moving all these drugs to non-prescription will make them significantly more expensive to me and all the millions of other people who pay for them now through their insurance.
Now, of course, you might think that insurance providers would be happy to fund these drugs even while over-the-counter, since it's far cheaper to subsidize (for example) blood pressure or cholesterol-lowering medication for life than cover one emergency trip to the hospital and bypass surgery, but I really don't think most insurance providers think that way.
It doesn't hurt to be nice.
Statins and albuterol are quite safe for most people, but letting the average guy decide to use them is pretty dangerous. To quote George Carlin: think of how stupid the average person is, then realize that half of them are stupider than that.
I think what makes a lot more sense is for long-term prescriptions - a kid with asthma is going to need an inhaler for years, and a kid allergic to bee stings or peanuts or something is going to need an Epi-Pen for the rest of his life. It makes a lot of sense to give a prescription for a year or two.
But on the other hand, the prescription is a good "timer" - my father has high cholesterol (even on a near-no cholesterol diet) so he's on Lipitor and will be for the foreseeable future. His prescription lasts almost exactly 3 months, at which time he goes to his cardiologist for bloodwork anyway. That makes sense to me - most of these conditions require some attention, and having the prescription run out is a good way to get it.
I have developed a truly marvelous proof of this comment, which this signature is too narrow to contain.
"Ask your Rx Kiosk Today about Effluvium DX."
"Effluvium. For Whatever You Have."
Patients taking Effluvium have reported Dry Mouth, Disorientation, and Spontaneous Testicular Detonation. Effluvium should not be taken before operating heavy machinery, using social media, driving or eating. Read and sign the Effluvium arbitration agreement and release from liability before taking Effluvium DX.
So I can self diagnose high cholesterol on the honor system at a kiosk, and yet, cough syrup and Pseudoephedrine have to be regulated...
for corporate drug pushers (aka "drug companies") and their shareholders.
Its the other way around. Now instead of getting insurance to pay $500/month or whatever for prescription blood pressure pills, you'll have to try to get $500/month from the end user directly... good luck with that.
"Science flies us to the moon. Religion flies us into buildings." - Victor Stenger
Lisinopril. It's one of the most common prescription medications on earth, and is so inexpensive that it's easily affordable without insurance. Yet doctors hold your refills hostage to expensive monthly office visits, which consist in their entirety of a nurse practitioner taking your weight and blood pressure, measurements anyone with high blood pressure already takes at home. This nonsense must stop.
Oliver's law of assumed responsibility: If you're seen fixing it, you will be blamed for breaking it.
But mostly a lose for patients.
The reason it's a win for doctors is that in our "fee for service" system they don't make much on a simple office visit, especially if they have to take the time to write a prescription. There's also ongoing overhead for prescriptions - whenever you run out of refills the pharmacy has to reauth, which takes up staff time. (This last is why the office where my son works has additional staff on hand on fridays, which is the day that everyone does their refills.) It may also reduce liability, although exactly how that will play out is harder to predict.
It's an obvious win for insurance because most OTC stuff isn't covered. And likewise for drug companies, who will sell more product, a lot of it to people who don't really need it.
The big losers will be patients. Sure, some people will have easier access to the meds they need. But costs will overall be higher, and some of the meds they are talking about aren't all that safe. Statins, for example, may be great at treating high cholesterol, but over time they can cause liver damage. Most of the antihypertensives are reasonably safe when taken at the correct dose, but take a bit too much and things like positional vertigo can occur. And as others have pointed out, the inability to track OTC meds can result in serious drug interactions or overdoses. Indeed, this is already a serious problem with acetaminenophen - so many different products contain it that it's easy to get an overdose, and boom goes your liver.
Try being diabetic. What a dick-dance to get basic survival supplies which are RATIONED to maintain a REVENUE stream...
"This post is an artistic work of fiction and falsehood. Only a fool would take anything posted here as fact."
I still cannot fathom why I have to have a prescription to order new eyeglasses or contact lenses. Yes, you should get your eyes checked out regularly, but a 2-year old prescription is still way better than no glasses at all!
What about birth control? If 90% of women are using it, why can't we just get it over the counter without having to pay for a doctor's visit first?
Not that I'm against this necessarily, but it is interesting to note that these drugs which are currently prescription-only and which do have side-effects might be available over the counter, along with aceteminophen (Tylenol) which causes approx 400 deaths in the US per year, which can be purchased by children... ...but the feds just closed the medical cannabis dispensary nearest me despite it having won awards from the city and being backed by the Chamber of Commerce, having tight security, etc... because although it's over 600 feet from a school (state law) at 960 feet it's less than 1000 feet from a school for the blind by 40 feet... so it had to be shut or the landlord would face criminal charges and asset seizure.
There's a Walgreens on the corner. Sells tylenol, etc. Also a whole isle of candy bars for the kids.
Interesting.
This space available.
In some places, patients can. I haven't been able to nail it down, but some law changed somewhere, and labs are no longer willing to permit walk in patients. Maybe this is just a California thing. Don't know. (Our laws are notoriously messed up.)
You should be able to walk into a lab and receive a test, any test, just as long as you pay for it. To deny patients this ability is to deliberately increase both risk and cost.
You should be able to walk into a lab and receive a test, any test, just as long as you pay for it. To deny patients this ability is to deliberately increase both risk and cost.
What should be and what is are very different things. I was getting a blood test in a lab, and realized I didn't know my blood type. So I walked up to the counter, plunked down my credit card, and said I wanted my blood type tested. Sorry, no can do, you need a prescription.
I think it's obscene to have to ask permission from duly deputized government agents to get a blood test. But that's the way it is. I've seen all sorts of comments, but none addressing the fundamental question - why do I have to ask permission from the government to get a blood test or take medicine? Why do I have to pay a 1000% markup on my medicine through regulatory rent seeking?
There's all sorts of squawk about "drug legalization", but always for drugs that get me high. How about they keep the pot, and legalize simvastatin and metformin?
And whaddya know, the FDA is actually talking about giving up some control and maybe leaving me free to make these choices for myself. A teeny tiny step in the right direction. I should look out the window to check for a flock of donkeys flying by.
If only the general principle would catch on. There are endless things that are bad for us that are legal - how about we legalize the things that might be good for us?
An FDA type agency is necessary to prevent snake-oil salespeople, but, yes, they shouldn't be in the business of telling people what to or not to put in their own bodies. You'd think Roe-v-Wade could be generalized to this, but no.
If an adult wants to inject used motor oil into their veins, more power to them. But if someone tries to sell used motor oil as "Magic Tree Oil" that will cure cancer, then it time for someone to force them to offer proof.
All ideas^H^H^H^H^Hprocesses in this post are Patent Pending. (as well as the process of patenting all postings)