OTC Antacid May Be as Effective as Prescription
Jan. 23, 2007 — -- A widely available over-the-counter treatment for heartburn and acid reflux may provide the same benefits as prescription drugs nearly 10 times the cost, according to a Consumer Reports analysis released Monday.
But some physicians who prescribe these medicines say consumers may not reap the benefits of the savings -- and they may even end up paying more for OTC treatment than they would for prescription drugs.
The analysis suggests that Prilosec, an OTC version of a class of drugs known as a Proton Pump Inhibitors, or PPIs, carries the same benefits for patients as two prescription medicines in the same class, Prevacid and Nexium.
Prilosec costs $19 to $26 a month on average nationwide, compared to between $100 and $200 per month for prescription PPIs.
The report cites a detailed evaluation of scientific evidence and it concludes that the PPIs are equally effective in treating heartburn or gastroesophageal reflux disease, a condition commonly known as GERD.
"Many patients are on PPIs and for years we have used Prilosec OTC with no problem," says Dr. Neil Brooks, former president of the American Academy of Family Physicians, who currently oversees a large nursing home population. "I do not believe there is any difference between the OTC and prescription drugs."
"It has been well-known for years that all PPIs give about the same symptom relief," says Dr. Walter Peterson, Professor Emeritus of Medicine at the University of Texas Southwestern Medical Center in Dallas. "I have always focused on symptoms and told my patients to use the cheapest PPI they could find. The bottom line is that for relief of heartburn symptoms, all PPIs are equal."
Physicians Disagree Over Findings
Not all doctors, however, believe that Prilosec provides the same degree of results as its prescription counterparts.
"I find this finding very hard to believe and I would want to see the actual 'scientific evidence' it was based on," says Dr. Roshini Rajapaksa, assistant professor of medicine at the New York University School of Medicine.
Others say that while a non-prescription medicine may offer some relief, it is unlikely that it will be as potent as a prescription drug.
The other point of contention is cost. The analysis says many patients could save $1,000 to $2,000 per year by switching to Prilosec -- "dramatic" savings that "illustrate why consumers should talk to their doctors about identifying effective, lower-cost medicines," said Gail Shearer, director of the Consumer Reports Best Buy Drugs project, in a press release issued Monday.
But other physicians dispute the idea that these medicines are cheaper for the patient.
Though the OTC medications may be equivalent in function to their prescription counterparts, they are not necessarily less expensive.
"[T]hey are not necessarily available at one-tenth the cost," says Dr. Joel Weinstock, division chief of gastroenterology at Tufts New England Medical Center.
And in some instances in which insurance is involved, OTC preparations may be even more expensive than prescription medications.
"The question is, cheaper for whom?" says Dr. Thomas Schwenk of the department of family medicine at the University of Michigan in Ann Arbor. "Many patients ask physicians to write for prescription drugs because the co-pay on the prescription is cheaper than the full cost of the OTC form."
So even though the drugs are cheaper in the absolute sense, Schwenk says, insurance may not pick up any of the cost -- making the OTC drugs more expensive overall for the patient.
"Only in America could we design a health care system with such perverse incentives," he says.
OTC or Prescription, Patients Must Heed Physician Advice
Some doctors also worry that patients' perception of Prilosec as an OTC drug could make it more likely that they will not use it as seriously as they would a prescription drug.
"My only concern is that in the case where a patient needs the PPI for the treatment of significant disease they may not take it because it is OTC and not prescription," Brooks says.
Even worse, some patients may feel that they can simply self-medicate without seeing a doctor. While this strategy may eliminate the burning discomfort of acid reflux, it may also make it less likely that other more serious conditions will be properly diagnosed and treated.
Rajapaksa says patients shouldn't skip their doctor's visit just because an antacid is OTC.
"It is worrisome when patients treat themselves -- even if their GERD symptoms are improved, they may still have dangerous complications from GERD that should be evaluated by a physician," Rajapaksa says.
"I would tell GERD patients that we need to see the evidence before believing this report, and for now, they should seek medical attention for GERD and follow their doctor's recommendations," he says.