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PROFIT IDEAS Don’t Fall Behind the Times on Behind the Counter Rx-to-OTC drug switches are notorious for making headlines. Another class of drug has historically received less attention, but is now getting press as consumers and policy-makers both look for ways to trim increasing healthcare costs, improve patient safety and reduce potential abuse: BTC, or behind-the-counter. BTC drugs are defined as your basic OTC products that can be sold without a doctor’s prescription but that must be sold with a pharmacist’s supervision. For example, the much-written-about Plan B drug can and is being sold in many states from behind the pharmacy counter without the intervention of a physician. In the United Kingdom and other areas of the world, the BTC class of drugs is commonplace and accepted. Pharmacists guard it — almost jealously — and consumers are used to it.
Pro and Con Here in the United States, where BTC is not an official drug class, it is meeting with both cheers and jeers from different sectors: consumers, pharmacists, product manufacturers and advocacy groups. Who is on one side or another differs depending on the context in which the issue is presented. When it comes to pharmacists, benefits and drawbacks seem to be equally balanced. On the one hand, a behind-the-counter class of drugs may present difficulties for pharmacists. Where will they find the time to interact so closely with so many patients? Are customers really going to ask for a BTC medicine, or will they just settle for what they can find on the shelf? Don’t customers prefer to serve themselves, anyway? And, after all, shouldn’t drugs be as accessible as possible to the people who need them? On the other hand, pharmacists can’t help but see the potential benefits to BTC drugs. When customers must approach the pharmacy counter to request a specific product, an opportunity for genuine interaction falls directly into the pharmacist’s hands. One of the chief complaints of thousands of pharmacists is that they have been relegated to the role of pill counter, especially in large chain operations. It is feared that this minimization of their contribution to healthcare makes an impression on customers, who mistakenly come to regard pharmacists as mere gatekeepers to the medicines they need.
Behind-the-Counter, But a Step Ahead In a 2005 article by health policy scholar Robert I. Field appearing in the journal Pharmacy and Therapeutics, he points out that people are waking up to the fact that physicians are not the only healthcare professionals capable of regulating access to drugs. Pharmacists, he says, “are thoroughly trained in the uses and risks” of medicines and “often render detailed advice to patients on both prescription and OTC products.” After all, if nurse practitioners, physician assistants and psychologists — all of whom have less instruction in pharmaceuticals than pharmacists — can prescribe drugs in some cases, why shouldn’t pharmacists be allowed to control access to drugs that are safe enough not to require a prescription, but not safe enough to allow customers unsupervised access? Of course, there are plenty of issues to be hammered out before BTC could become a workable reality. How would pharmacists be compensated for this extra demand on their time? Will enough pharmacists seek additional training to be able to work with customers’ varied needs? Where within already cramped quarters will this array of BTC drugs be shelved? How will customers and other healthcare providers respond to pharmacists as advisors? |