U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

something like 20% of US health spend is on outpatient care. i dont know how much of that relates to medication management, but id imagine a lot does. PCPs get paid more when they manage a patients medication, and many psychiatrists make nearly all their income from adjusting prescriptions. im sure other specialties are similar. so this theoretically enables some of that work to be done without the physician. this could significantly reduce cost of outpt services, although it will depend very much on how hard it is for pharma companies to demonstrate non rx use of their products is safe and effective. it may be the case that only a few meds actually are eligible, or that many are, once the guidance is finalized

i havent read the guidance doc yet so dont really know how this would play out in terms of who decides what to rx if not a doc.

i personally am sort of disappointed to see doctors becoming even more sidelined. doctors really do an important job of filtering info for patients, advocating / negotiating with insurance companies, and looking out for them. this could potentially be one less protection for patients as large companies get more power to control info. id like to see cost taken out of the system by reducing pricing power by breaking up large providers rather than disintermediating doctors, but that isnt within fda's mandate, so i understand why fda would go for something like this

this could be good for patients if it is implemented in a way that doesnt give pharma too much power over patients. cost would decrease and access to meds could increase. however there may be more patients taking medicines for reasons other than the health benefits (ie marketing power / influence)

My personal logic is they typically have lobbied to keep most drugs regulated (or split) so to keep their reimbursements as high as possible. Most drugs once they go into the OTC market drop in margin, and volume does pick up but only to a point plus it comes with increased competition now.

The last few allergy medications like Zertec, Allegra, Claritin etc that were once prescription only went OTC and margins dropped for the OTC versions. However, you will find at least in the case of a couple of them the companies were pushing for them to be OTC from the beginning because they had developed the drug with the intent to be OTC. However, even if you look at OTC allergy meds, most can still be prescribed and hence paid for by medical insurance and the per pill price is drastically higher, but the out of pocket expense for the consumer is lower (which is just screwed up IMO). Last point on this, once it goes OTC the competition on manufacturing skyrockets, again driving down margins for everyone, similar to when a prescription med comes off patent initially.

I could see an argument though where the AMA and other physician lobbying groups here may diverge from the pharmaceutical lobbying but in general from my knowledge they work pretty close together.