White House Should Expedite Plans to Boost Access to OTC Drugs

President Trump released  The-Great-Healthcare-Plan in January 2026. The plan was summarized on one page and illustrated the White House’s plans to restrain medical spending and increase access to care. Among the topics were lower drug prices, lower insurance premiums, holding big insurance companies accountable and maximizing price transparency. One subtopic stood out, and it is probably the one policy wonks will pay the least attention to. Yet it arguably has the most power to help achieve Trump’s goals of boosting access to care while holding costs down. That is: 

Allow More Over-the-Counter Medicines. Make more verified safe pharmaceutical drugs available for over-the-counter purchase. This will lower healthcare costs and increase consumer choice by strengthening price transparency, increasing competition, and reducing the need for costly and time consuming doctor’s visits.

Americans see their doctors more than a billion times each year — about half of their visits are to see a primary care physician. One reason people see their doctors is to renew a prescription medication. Nearly half of physician visits result in a prescription. One survey of primary care physicians found that many office visits were for conditions that could have been treated at home. Indeed, eliminating office visits for conditions that do not require a physician’s care is the primary way non-prescription medications save money and avoid inconvenience. One industry estimate found that Americans save themselves (and the health care system) $6 to $7 for every $1 spent on a nonprescription drug. This is significant considering Americans spend roughly $100 billion per year on nonprescription drugs. More than 700 OTC drugs were once only available by prescription, but this number could easily increase. 

At least initially, the care most people receive is self-care using over-the-counter drugs. The price of a prescription drug falls about 95% after the exclusive period expires, it is approved for OTC use, and other manufacturers begin to produce their own OTC versions. For example, Prilosec was once a popular prescription stomach acid reducer. Prior to losing patent protection and being approved for OTC sales, it cost around $4 per dose. Nowadays the generic version (Omeprazole) is available at Walmart for $9.97 for 42 tablets, or about $0.24 cents a dose. That represents a 94% reduction over what the drug once cost when available only by prescription. A vendor on eBay offers a 500-count box for $74.99, or about $0.15 cents apiece. That represents a 96% decrease. Prescription Claritin cost about $75 a month for a 30-day supply in 2001, or about $2.50 per tablet. Nowadays an entire 365-day supply is only $30.27 for the OTC generic loratadine. That works out to slightly more than $0.08 cents a tablet, or about 97% less than the prescription drug 25 years ago.

The U.S. Food and Drug Administration (FDA) requires an application to switch a drug from Rx only to OTC. This requires studies showing that a condition is easy to self-diagnose, the drug is easy to administer and safe enough to self-medicate. The sponsor (i.e., the manufacturer) is the only party allowed to apply for an Rx to OTC switch. This makes little sense. Any party willing to manufacture a drug that has lost patent protection should be allowed to petition the FDA to sell a drug over the counter. Furthermore, the FDA should take the initiative and identify drugs safe enough for OTC sales then solicit parties willing to apply. 

Conclusion. As my examples above illustrate, drug prices fall once they become generic and are sold over the counter. This is due to price transparency, consumers’ price sensitivity and competition from retail stores. Under current regulations, the FDA is basically protecting the profits of drug developers by helping them avoid the kind of competition that occurs when consumers compare prices. It should not be the job of the FDA to protect prices by requiring safe drugs to be sold only by prescription. While manufacturers should be free to negotiate distribution agreements with pharmacies, the federal agency should not facilitate higher prices through drug regulation.