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Over-the-Counter Vs. Prescription Drug Use

The use and misuse of drugs in nursing homes remains a critical issue for clinicians and policymakers and has been a subject frequently covered in the professional literature. However, no published studies have distinguished between over-the-counter (OTC) medications and prescription (Rx) medications in the nursing home population. This distinction is important for two reasons: 1) OTCs are generally less expensive than Rx drugs; and 2) most prescription plans available to nursing home residents do not cover OTCs, with the new Part D benefit explicitly excluding them from coverage. To document the use of OTC and Rx drugs—particularly in situations where they easily may be substituted for one another—the authors examined 2001 data on 789 Medicare beneficiaries in nursing homes. They also studied the impact of supplemental insurance coverage on the selection of OTC versus Rx medication. The authors hypothesized that residents without drug coverage and those with Medicaid coverage, which covered a variety of common OTCs before 2006, would be more likely than residents with private insurance to use OTCs. However, their findings indicated that coverage did not appear to influence the choice of OTC versus Rx medications. The authors suggest that Part D coverage (enacted after the data used in this study was collected) will likely have a future effect on utilization of Rx drugs when OTC medications are available. OTC-to-Rx switching among the nursing home population should continue to be monitored, as the lack of coverage for OTC drugs may create an incentive to use Rx drugs, which are frequently more expensive and more potent.

L. Simoni-Wastila, B. C. Stuart, and T. Shaffer, Over-the-Counter Drug Use by Medicare Beneficiaries in Nursing Homes: Implications for Practice and Policy, Journal of the American Geriatrics Society, October 2006 54(10): 1543–49

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