A Prescription-Free Way to Affordable Health

A new study finds that most seniors don't receive the blend of prescription drugs that they need. Carlo Allegri/reuters

One of America's largest doctor groups recently issued a stunning recommendation.

The American College of Physicians (ACP) is urging its 140,000 members to prescribe generic medications whenever possible, even if newer medicines are available. The ACP explains that people are far more likely to fill an inexpensive generic prescription because skyrocketing drug prices and insurance fees have made brand-name medicines increasingly unaffordable.

That recommendation, though a step in the right direction, doesn't go far enough. Often, the cheapest, safest and most effective treatments don't require a prescription at all.

It's time for doctors and insurers to steer patients to these non-prescription remedies. Doing so would save patients billions while improving their health.

Prescription drug prices keep rising. List prices for brand-name drugs jumped almost 15 percent in 2015. Even generic prices rose 3 percent.

Insurers increasingly pass on these costs to patients. Patients' average out-of-pocket spending jumped 77 percent from 2004 to 2014. Spending on insurance deductibles rose eight times as fast as wages. And expenditures on co-insurance—an arrangement that forces patients to pay a large percentage of each prescription's cost—more than doubled.

Many patients can't afford these costs. So they respond by skipping doses to make their prescriptions last longer. Or they don't fill the prescriptions at all—and become sicker as a result.

Doctors could prevent much of this non-adherence, which costs the nation up to $300 billion a year, by encouraging patients to use affordable non-prescription alternatives first.

Most Americans are familiar with non-prescription remedies such as Tylenol, Allegra and Imodium. Consumers can obtain these products at local pharmacies, retail stores and even online without a doctor's prescription.

Many people assume that if a product doesn't require a prescription, it's less effective. Not true. More than 700 over-the-counter (OTC) products were once available only by prescription.

Consider the range of treatments for irritable bowel syndrome, a combination of diarrhea and constipation that plagues up to 55 million Americans. Most physicians initially advise IBS sufferers to make dietary modifications, such as eating smaller meals throughout the day or avoiding fatty foods.

If that doesn't work, doctors typically default to "drug 'em up" mode, saddling patients with high costs in the process. New prescription options for irritable bowel syndrome can cost as much as $19 per tablet.

Patients may fare better if doctors recommended non-prescription remedies before reaching for their prescription pads. One such IBS remedy, IBgard, sells for 63 cents per capsule, and according to recent clinical studies, it decreases IBS symptoms by 40 percent after four weeks. Other testing shows that another non-prescription remedy, Miralax—which costs less than a dollar per dose—relieves IBS-related constipation in the overwhelming majority of patients.

Non-prescription remedies effectively treat a host of other common ailments too. Prilosec, for instance, controls acid reflux disease just as well as prescription medications, according to recent studies. Non-prescription anti-inflammatory treatments, such as Aleve, reduce joint pain about as much as prescription Celebrex.

These equally effective treatments can help to protect patients' bank accounts as well as bodies. While the average brand-name prescription costs about $268 and the typical generic prescription costs $33, the average non-prescription remedy sets consumers back less than $10.

All told, non-prescription drugs save Americans $102 billion a year. That's a third of the nation's total pharmaceutical spending.

Non-prescription treatments also come with fewer side effects and health risks. For instance, researchers have discovered that a non-prescription, 200-milligram tablet of ibuprofen—the active ingredient in Advil—curbs pain as effectively as a 10-milligram dose of prescription morphine. The latter treatment, of course, is highly addictive and can lead to drug abuse.

Doctors aren't the only ones who ought to encourage greater adoption of non-prescription remedies. Insurers should too.

Currently, many insurance companies incentivize doctors and patients to use inexpensive treatments by keeping co-pays low for generic drugs while charging high co-insurance fees for expensive brand-name medicines. Yet these companies neglect to cover many non-prescription remedies. That forces patients to pay the full price out of pocket.

Expanded coverage for such remedies would give doctors and patients a financial incentive to try non-prescription options before resorting to expensive drugs. Congress could also further encourage non-prescription drugs by repealing the medicine cabinet tax on OTC drugs and allowing consumers to us their health savings accounts and flexible spending accounts to purchase non-prescription drugs.

Non-prescription treatments boost patients' health without breaking the bank. By encouraging increased use of these therapies, physicians and insurers could trim ballooning health care bills and ensure patients can actually afford to follow their doctors' orders.

Devon Herrick is a health care economist who serves as a senior fellow at the National Center for Policy Analysis.