Will Someone Please Pay for my Rubbers

[DolfanBob]

Is the pill A-Dicktive?
Again I know, I'm juvenile. 

[Gaspar]

Is the pill A-Dicktive?
Again I know, I'm juvenile. 

Every woman's body is different.  Some respond to small amounts of hormone, and others require much larger doses.  Women with significant history of blod clots and those with family history of breast cancer need to be monitored more frequently.  Some women cannot tollerate BC at all, and others can have adverse reactions especially if started too young. Over the counter access to hormonal treatments is very unwise.  Frightened young girls that fear seeing a doctor because mommy might find out can seriously screw themselves up for life by misusing BC. 

It's not like there is some kind of shortage or access problem.  This is a rather stupid proposal, because only the stupidest of physicians would ever consider it.  It would never pass the FDA, even in a post Fluke world.

[nathanm]

Please explain why I should trust your assessment over that of actual doctors? I seriously doubt the adverse effects of hormonal BCPs are any worse than the adverse effects of aspirin on the very young or acetaminophen on anyone. An entire month's worth of modern BCP probably has less hormones in it than a single pill did in the 70s.

The irony is that if they just called it a dietary supplement, they could sell as much of it as they want over the counter and nobody could say boo. I'm pretty sure you're OK with that. St. John's Wort kills many people every year from drug interactions, yet nobody is foaming at the mouth about it.

[Gaspar]

Please explain why I should trust your assessment over that of actual doctors? I seriously doubt the adverse effects of hormonal BCPs are any worse than the adverse effects of aspirin on the very young or acetaminophen on anyone. An entire month's worth of modern BCP probably has less hormones in it than a single pill did in the 70s.

The irony is that if they just called it a dietary supplement, they could sell as much of it as they want over the counter and nobody could say boo. I'm pretty sure you're OK with that. St. John's Wort kills many people every year from drug interactions, yet nobody is foaming at the mouth about it.

This is a "news item."  I would be very surprised if there is a majority of MDs in the real world willing to recommend over the counter hormonal treatments of any kind.  It's not a drug, it's a natural/synthesized human hormone.  The risks, and therefore liabilities are huge.   Application without some form of supervision is just not smart.  When you've had to treat a completely healthy 24yo girl for pulmonary embolism a month after starting birth control because her doctor didn't get a complete history you can make such generalities.   The "amount" of active hormone in the preparation is far less important than the body's response to it.  As I stated before, some women cannot cannot cannot tolerate it at all, and worse, some may not know until they are prescribed.  It's not one-shoe-fits all.  It is absolutely necessary for a physician to get a medical history and instruct the patient as to what to expect.

[Townsend]

This is a "news item." 

What isn't a "news item" when it's in the news?

This is a finding from the American Congress of Obstetrician and Gynecologists. 

[Gaspar]

What isn't a "news item" when it's in the news?

This is a finding from the American Congress of Obstetrician and Gynecologists. 

I know.  I still find it very stupid.  Many of the articles cite the fact that other countries allow OTC birth control, and somehow imply that we are behind.  India has OTC birth control, they also have OTC antibiotics and as a result, all kinds of new and terrible multi-antibiotic resistant bacterial infections, including some amazing zygomycotic necrotizing fasciitis.   You can go to the pharmacy and buy antibiotics by the pill, no need to take a whole dose or have a physician even determine if your infection is covered in the spectrum.

Just because you CAN do something, doesn't mean it's SMART to do so.

[Townsend]

I know.  I still find it very stupid.  Many of the articles cite the fact that other countries allow OTC birth control, and somehow imply that we are behind.  India has OTC birth control, they also have OTC antibiotics and as a result, all kinds of new and terrible multi-antibiotic resistant bacterial infections, including some amazing zygomycotic necrotizing fasciitis.   You can go to the pharmacy and buy antibiotics by the pill, no need to take a whole dose or have a physician even determine if your infection is covered in the spectrum.

Just because you CAN do something, doesn't mean it's SMART to do so.

This is birth control.  Antibiotics aren't being pushed for over-the-counter by the American Congress of Obstetrician and Gynecologists.  At lease not in this article.

[Gaspar]

This is birth control.  Antibiotics aren't being pushed for over-the-counter by the American Congress of Obstetrician and Gynecologists.  At lease not in this article.

I would be willing to bet that the drug companies are behind this.  With BC becoming a popular target "gubment" program, they have a lot to lose if their primary reimbursement is to come from a negotiated exchange or an eventual single payer system.  They would be clever to get out from under it by becoming an OTC drug.  That way they can charge retail prices.

I'm willing to bet it won't be too long before other drugs see a push for the same. 

[Red Arrow]

They would be clever to get out from under it by becoming an OTC drug.  That way they can charge retail prices.

At least one odd exception is prescription generic Zantac.  It's a LOT less expensive than the OTC brand name pills.  It's one of the WalMart $10 for 3 months (180 pills) drugs.

Edit:
http://www.walmart.com/ip/10309841?adid=22222222227001218544&wmlspartner=wlpa&wl0=&wl1=g&wl2=&wl3=14115580030&wl4=&wl5=pla&veh=sem

[nathanm]

I would be willing to bet that the drug companies are behind this.  With BC becoming a popular target "gubment" program, they have a lot to lose if their primary reimbursement is to come from a negotiated exchange or an eventual single payer system.  They would be clever to get out from under it by becoming an OTC drug.  That way they can charge retail prices.

Paranoid much? Given how cheap generic BCP is already, I seriously doubt they'll somehow be able to charge more if it goes OTC. Teva don't play that. Did Prilosec and Zantac and Pepcid's prices go up when they went OTC?

I'm willing to bet it won't be too long before other drugs see a push for the same. 

When haven't drug companies been trying to get permission to sell over the counter?

I'm surprised that you haven't had the experience of watching someone die over a period of days from liver failure brought on by an acetaminophen overdose if you've seen someone nearly killed by a blood clot caused by BCP. (You probably never saw the person with seratonin syndrome from St. John's Wort unless you were an EMT..they went straight to the morgue) Should we put that behind the counter? There are lots of countries that don't sell it OTC like we do. It kills over 450 people a year in the US alone.

BTW, pregnancy itself carries a clotting risk over twice what the combined BCP does and in the post partum period it's about 10 times that of combined BCP. Interestingly, progestin-only pills do not appear to have any detectable clotting risk. What we should not do is approve products containing drospirenone, which has a much higher clotting risk than the normal combined pill.

[Red Arrow]

Given how cheap generic BCP is already,

A few months ago you were telling us how many women cannot use the cheap stuff.

[nathanm]

A few months ago you were telling us how many women cannot use the cheap stuff.

Indeed, many can't. Most can, especially now that the low dose 3 step combined pills are off patent. Some may still need the brand name, but that's got love all to do with what we're discussing right now.

[Red Arrow]

Indeed, many can't. Most can, especially now that the low dose 3 step combined pills are off patent. Some may still need the brand name, but that's got love all to do with what we're discussing right now.

Supposedly, price is one advantage of any drug going OTC.  You are now saying that the generic price is cheap enough for most women where before you were saying that most women could not afford contraception.  Where is the advantage of going OTC?

[nathanm]

Supposedly, price is one advantage of any drug going OTC.  You are now saying that the generic price is cheap enough for most women where before you were saying that most women could not afford contraception.  Where is the advantage of going OTC?

What I said was that the generic price is low enough that there's not a lot of room for insurers to bargain further. Moreover, I never said "most" women cannot afford contraception. I have said that insurance companies should be required to cover it the same as they would any other medication, regardless of their (or a group plan sponsor's) feelings on the matter, since it is often used for the treatment or management of medical conditions.

[Red Arrow]

Moreover, I never said "most" women cannot afford contraception. I have said that insurance companies should be required to cover it the same as they would any other medication, regardless of their (or a group plan sponsor's) feelings on the matter, since it is often used for the treatment or management of medical conditions.

I sure got the impression that you thought the reason it should be covered was due largely (but not entirely) to the cost.  I'm not going searching for individual posts though.