Both the Medicare program and patients often pay more for nonprescription drugs that are purchased as prescriptions under Part D than if purchased OTC, researchers report. “Previous research showed the Medicare Part D Program overpaid for common generic drugs compared with prices available at large-scale retailers or the Mark Cuban Cost Plus Drug Company,” the authors write. “However, those studies required that patients obtain a prescription to take advantage of the lower prices; this study shows that drugs could be available for less and without a prescription. For drugs available OTC, the Medicare Part D program should encourage plans to consider OTC cash prices when negotiating with manufacturers and require that pharmacies notify patients of cheaper OTC options.”
The investigators used the FDA’s Orange Book on Nov. 1, 2022, to identify drugs approved as prescription and OTC. For a 20% national random sample of Medicare Part D pharmacy claims data, the OTC cash prices in the Amazon price tracker Keepa.com and Part D spending showed the following: “A total of 22 dual OTC and prescription drugs were identified, of which 20 drugs had Medicare claims in 2020 and 19 had OTC prices available. The 19 drugs represented 27 million claims and $716 million in spending in Medicare Part D in 2020. For 16 of the 19 drugs, OTC cash prices were lower than Medicare’s per-unit spending, with savings ranging from 10% to 97% per drug per year ($ 79,800 to $121 million). Overall, total spending could have been reduced by $406 million (57%) if the OTC cash price had been paid for all 19 drugs. After the deductible, beneficiaries paid more for the out-of-pocket costs than the cash price in 10% or more of the claims for 4 drugs: mometasone furoate 50 μg (13.9%); omeprazole/sodium bicarbonate 20 mg to 1.1 g (16.7%); azelastine hydrochloride 205.5 μg (18.2%); and lansoprazole 15 mg (18.3%).”