Paying Through the Nose

The first time I filled a prescription for Claritin, I did a double take when I saw the price: about $70 for 30 tablets. Neither the doctor nor the pharmacist, both of whom apparently assumed I had prescription drug coverage, warned me that the stuff would be so expensive.

I've been nursing that bottle for more than a year. The pills work very well for allergy symptoms, they last all day, and they don't make you drowsy. But given the cost, I've been using them only as a last resort, when my eyes are tearing, my nose is dripping, and my throat is itching even after I've taken over-the-counter remedies. I have one Claritin left, and I'm saving it for a special occasion.

I was therefore pleased to hear that the Food and Drug Administration might allow Claritin and two other allergy drugs, Allegra and Zyrtec, to be sold without a prescription. That would mean I could get them without paying for a visit to the doctor, and the savings from prepackaging would tend to reduce the retail price. More important, because the drugs would no longer be covered by prescription plans, consumers would actually care how much they cost, and the manufacturers would be forced to cut prices.

In the United States, the cheapest price I could find for Claritin, from an online pharmacy, was $2.05 a pill, and local drugstores charge more. In Canada, where Claritin has been available over the counter since it was introduced there in 1989, it sells for about 70 cents.

Even if some of that difference is due to other factors, it's pretty clear that allergy sufferers without drug coverage would gain if the FDA decided to lift the prescription requirement. So would insurance companies, which is why they're pushing for the change.

"Prescription drug costs are increasing at a rate that's not sustainable," a spokesman for Wellpoint Health Networks told The New York Times. "We filed this petition to make health care more affordable."

This argument is obviously self-serving–Wellpoint is interested in cutting its own costs, not in saving money for other people–but there's some truth to it. Although consumers with prescription plans pay little or nothing for Claritin, Allegra, and Zyrtec at the point of sale, the cost of these medications shows up in higher insurance rates.

The insurers also have a point when they argue that the prescription allergy drugs are safer than many over-the-counter remedies because they don't make you sleepy. Driving under the influence of antihistamines may not be a crime, but it can be just as hazardous as driving under the influence of alcohol.

An FDA advisory committee found Wellpoint's arguments so persuasive that it voted overwhelmingly to recommend over-the-counter status for the allergy drugs. But in an unusual twist, the manufacturers are opposing a switch. They clearly think they can make bigger profits by selling less for more than they can by selling more for less.

They can't say that, of course, and they can't very well argue that their products are unsafe. Instead, they say lifting the prescription requirement would cut doctors out of the loop, depriving consumers of their guidance.

"We don't believe this would be in patients' best interests," a spokesman for Schering-Plough, Claritin's manufacturer, told the Times. "We're concerned that the insurance company is trivializing the importance of the patient-physician relationship."

Physicians, perhaps worried that fewer office visits will mean less income, are lining up to agree. They warn that cases of asthma will go undiagnosed as people try to treat themselves rather than seeing a doctor.

The implication is that Americans are dumber than Canadians, who somehow can be trusted to buy Claritin without a doctor's permission. In any case, the same sort of argument could be made against over-the-counter sales of the existing nonprescription allergy remedies and many other drugs.

People with ulcers may try to soothe their stomachs with Pepto Bismol instead of seeking professional treatment. People with fractures may take Motrin for the pain instead of getting their bones set. Should prescriptions be required for these drugs as well?

Contrary to the way this controversy has been portrayed in the press, the FDA is not being asked to "force" anyone to do anything. It is being asked to lift a paternalistic restriction on individual freedom that serves mainly to enrich doctors and drug companies.