Widening Consumer Access to Medicines through Switching Medicines to Non-Prescription: A Six Country Comparison

Abstract

BackgroundSwitching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for this is inconclusive. Interest in switching medicines for certain long-term conditions has arisen in the United Kingdom, United States, and Europe, but such switches have been contentious. The objective of this study was then to provide a comprehensive comparison of progress in switch for medicines across six developed countries: the United States; the United Kingdom; Australia; Japan; the Netherlands; and New Zealand.MethodsA list of prescription-to-non-prescription medicine switches was systematically compiled. Three measures were used to compare switch activity across the countries: “progressive” switches from 2003 to 2013 (indicating incremental consumer benefit over current non-prescription medicines); “first-in-world” switches from 2003 to 2013; and switch date comparisons for selected medicines.ResultsNew Zealand was the most active in progressive switches from 2003 to 2013, with the United Kingdom and Japan not far behind. The United States, Australia and the Netherlands showed the least activity in this period. Few medicines for long-term conditions were switched, even in the United Kingdom and New Zealand where first-in-world switches were most likely. Switch of certain medicines took considerably longer in some countries than others. For example, a consumer in the United Kingdom could self-medicate with a non-sedating antihistamine 19 years earlier than a consumer in the United States.ConclusionProactivity in medicines switching, most notably in New Zealand and the United Kingdom, questions missed opportunities to enhance consumers' self-management in countries such as the United States.

Barriers to positive policy change that aims to increase access to medicines through reclassification: the case of oseltamivir in New Zealand

“…The reclassification of oseltamivir in NZ was a ‘first in world’ event[8], and this study provides some useful insights for both this product and reclassifications generally. Availability of oseltamivir without prescription elsewhere has been limited to very specific contexts such as patient group direction in the UK,[25] and from UK call centres or pharmacists in Norway during the influenza pandemic in 2009/2010 [24].…”

“…cardiovascular risk assessment for simvastatin) [5–7]. Within developed countries, NZ had the most reclassifications during the period 2003 to 2013 with 16 switches, five of which were described as ‘first‐in‐world’ including the reclassification of oseltamivir to allow pharmacist‐supervised non‐prescription sale [8]. The existence of a pharmacist‐only non‐prescription medicine category (requiring direct pharmacist involvement in the sale) is thought to have facilitated reclassification in NZ [8]…”

Continued Dispensing: What medications do patients believe should be available?

“…This controversy about effectiveness and benefit of dispensing asthma medications without a doctors' review raises the need to ensure that optimal patient outcomes are being achieved through appropriate monitoring. This suggests that down scheduling of Prescription Only Medication to Pharmacist Only Medication provides better access to such medication, (Gauld et al 2014) however appropriate patient supervision is essential, as is referral to the doctor whenever deemed necessary. (Abukres et al 2014) Disease sufferers were more likely to support inclusion of their medications into CD with the exception of patients with diabetes mellitus and indigestion.…”

Australian pharmacists: ready for increased non-prescription medicines reclassification

“…When compared with other countries with similar health systems, for example the UK and New Zealand, Australia’s reclassification appears to have fallen behind . Despite the goal of regulatory harmonisation between Australia and New Zealand, between 2003 and 2013, New Zealand allowed more drugs to be rescheduled than Australia, including the provision of pharmacist only supply of sildenafil for erectile dysfunction, triptans for migraine, trimethoprim for urinary tract infection (UTI) and oseltamivir for influenza . These medicines are currently S4 in Australia, suggesting that consumers may face unnecessary barriers to timely access for some medicines.…”