In Rough Economy, Patients Turn to OTC

OTC Guide, June 2009, Volume 13, Issue 1

Spending time counseling patients has always been an important part of a pharmacist’s professional role. In a difficult economy, it may be even more important.

A recent study by Kalorama Information revealed that consumers are taking an increasingly active role in self-medication due to rising healthcare costs, a large uninsured population, and an ever-expanding supply of choices in the OTC category.

Bruce Carlson, publisher of Kalorama Information, a health care market research company, said he doesn’t expect the trend to change any time soon. “Our research shows that OTC sales were just as brisk this year as they were last year, even in this economy where one would expect some electivity in purchases,” he said.

“Purchasing OTC drugs is also more convenient and money is saved avoiding doctors’ visits,” said Carlson. That trend, he said, is actually helping to fuel Rx to OTC switches. “Our research shows that pharmaceutical companies are trying for as many Rx to OTC switches as possible, because consumers prefer them. If a patient can skip the $30 or $40 copay for a doctor’s visit, especially in this economy, they want the OTC drug.”

Carlson said recent studies indicate that up to 40% of consumers do not fill a doctor’s prescription, and often substitute with an OTC alternative. “Ultimately, purchasing OTC drugs saves U.S. consumers around $15 billion annually,” said Carlson.

Unfortunately, the copay may not be all patients skip when they choose to self-medicate. Patients who are spending less time with their physicians still have unanswered questions about their medications—and that’s where pharmacists play a key role. As medication experts, pharmacists are the health care professionals best suited to provide patients with the information they need to make critical decisions about self-medicating, not only with OTC drugs, but with vitamins and supplements.

A recent survey by the American Pharmacists Association (APhA) found that on average, pharmacists counsel 31 patients per week about OTC medications and pharmacists believe 83% of consumers purchased OTC products that were recommended by their pharmacist.

APhA’s study also found that 84% of patients who sought their pharmacists’ advice did so because they were worried about using an OTC product with other prescription medications and 74% were worried about taking OTC products with a specific disease or condition.

“Consumers are confronted with an eight or ten foot section of OTCs in any given area and it can be bewildering to most people, which one is the best for their symptoms or which will work best for them,” said Lisa Fowler, director or management and personal affairs at the National Community Pharmacists Association (NCPA).

Nerander Dhallan, RPh, owner of River Rx in Bethesda, Maryland, said he has always fielded questions on OTC products. Dhallan said most questions are about aspirin. “Patients want to know if they really have to take one every day, what do they do if they miss a dose, if enteric-coated aspirin make a difference,” said Dhallan.

Increasingly, pharmacists are fielding more questions about vitamins and supplements. “There’s an increased interest in complementary and alternative medicine. While not every pharmacist will see the same value in these practices, it’s important to be aware of drug interactions,” said NCPA’s Fowler. “Manufacturers tout these products as being safe, but they still contain active substances that can have variable and unpredictable effects when they are taken with other medications. There’s not always good or reliable information out there when it comes to dietary supplements.”

Fowler said it’s interesting to note who the general public sees as a reliable source of information about these products. “When Dr. Oz is on Oprah talking about a product, it directly affects sales. Pharmacists need to know what’s in the news, since media coverage definitely drives what consumers will come into the pharmacy asking about.”

Dhallan said he has been counseling even more frequently on supplements and vitamins. While multivitamins remain the most popular products in the category, he agreed that media coverage of certain vitamins and supplements raise consumer interest and usually spark more questions about those products.

“Patients have a lot of questions on probiotics,” said Dhallan. “The products are more in the news and patients are buying more expensive products like Florator, which is $40 a month, or Align, which is $30 a month. Patients want to know whether or not these products are worth it, or whether they should just take acidophilus, which has been around for years and is cheap.”

He often counsels patients not to take an antibiotic at the same time as a probiotic, instructing them instead to wait a few hours so the two don’t cancel each other out. “Patients know they should take a probiotic to offset the effects of an antibiotic on the digestive tract, but they don’t realize they shouldn’t be taken together,” said Dhallan.

Dhallan has also been fielding an increased number of questions about vitamin D. “The single biggest jump in interest and questions is in vitamin D,” he said. “There’s been a lot of news coverage about how vitamin D helps with calcium absorption, and the benefits of taking vitamin D by itself.”

Maria Marzella Sulli, Pharm D, CGO, associate clinical professor at St. John’s University College of Pharmacy and Allied Health Professionals, said because patients are unlikely to ask their physicians about vitamins and supplements, they are often confused about how best to take these products.

“Responding to a question is one thing, but initiating the interaction sends a totally different message about the profession—especially when it comes to supplements,” said Sulli. “Pharmacists need to not only be available to answer questions, they need to be proactive.”

“Asking questions like, ‘I see you’re getting Vitamin D, how much are you planning on taking?’ or offering some tips on how to get the most from vitamin D are effective,” explained Sulli. “If a pharmacist sees a patient purchasing calcium carbonate and a proton pump inhibitor, the pharmacist can steer the patient to calcium citrate, which is a better choice for someone who is taking drugs to suppress acids.” Offering tips on how patients can get the most from their calcium supplements by taking 500 mg twice a day rather than 1000 mg once a day is also important information.

NCPA’s Fowler said sometimes questioning a patient can lead a pharmacist to recommend a physician’s visit. “Routine use of certain OTCs can mask a serious medical condition,” said Fowler. “If a pharmacist asks how long a patient has been experiencing heartburn, for example, they may recommend that the patient visit their doctor.”

Because patient interaction is crucial to the exchange of information, Sulli said it’s important that pharmacists set up their practice in a way that enables them to come face-to-face with patients. “Pharmacists should be the ones interacting,” Sulli asserted. “Pharmacists need to use every opportunity to have contact with the patient.”

She suggests that instead of answering the ‘where is the . . .’ question with ‘aisle one, bottom right,’ pharmacists can use the question as an opportunity to engage the patient by asking why they need the product, and how they are planning on taking it. The interaction will lead to a better exchange of information, give the patient the opportunity to get to know the pharmacist, and elevate the profession overall as consumers come to expect more from the pharmacists.