Fewer Prescriptions, Lower Costs Follow Claritin's OTC Switch, USA

After the allergy drug Claritin became available without a prescription in 2002, insurance plans and consumers spent less on the prescription form of its main ingredient, loratadine, and all similar allergy drugs, according to a new report published in this month's The American Journal of Managed Care.

Contrary to what Patrick Sullivan, Ph.D, of the University of Colorado School of Pharmacy, and colleagues expected, patients did not turn to other prescription drugs for allergies and asthma or to antibiotics in greater numbers after loratadine lost its prescription-only status.

"Instead, there were fewer prescriptions and lower costs for all drugs across the board," Sullivan says.

The decrease in costs occurred across all types of plans, regardless of whether loratadine was covered as a "preferred" drug, the researchers say.

Insurance plans may have saved money after Claritin's switch to OTC status in part because physicians wrote fewer prescriptions for antihistamines, the researchers found.

"Consumers appear to have benefited as well," Sullivan says, noting that the price of what had been the world's most-prescribed antihistamine is now lower than the average copayment for prescription antihistamines before the switch.

This class of drugs also includes cetirizine (Zyrtec) and fexofenadine (Allegra). The drugs treat seasonal allergies and chronic nasal congestion without some of the side effects, such as drowsiness, of early antihistamines.

When loratadine became an over-the-counter product in December 2002, some insurance plans moved the drug into their third tier of coverage, a group of brand name drugs that have an effective and less costly generic equivalent. Third-tier drugs generally have the highest prescription costs and copayments within an insurance plan.

Other plans made no change to loratadine's status, while other sponsors, including many Medicaid managed care plans, offered loratadine under its original prescription status only to patients who had been prescribed the drug prior to its OTC switch.

A year after any plan changes, patients with third-tier coverage for second-generation antihistamines paid $11.40 more a prescription. Those under restricted plans paid $1.70 less a prescription, while there was no change in price under plans that kept the same coverage.

When Sullivan and colleagues calculated copayment costs based on how many prescriptions each person filled a month, however, average copayment costs fell 23 percent in third-tier plans and 46 percent to 64 percent in the no-change and restricted plans.

The difference may be a result of patients obtaining fewer prescriptions for the drugs. The average number of prescriptions filled for each person a month fell at least 46 percent during the study, the researchers found.

Sullivan says it is possible that allergy patients "were able to obtain adequate treatment with over-the-counter loratadine and had less need to contact the health plan for the treatment of their primary condition."

The researchers say it is unclear whether patients who used fewer prescription second-generation antihistamines treated themselves properly with OTC loratadine, or whether they turned in greater numbers to older OTC drugs such as Benadryl.

"This effect would be detrimental to society and should be examined in future research," Sullivan and colleagues say.

The study was supported by a grant from Schering-Plough, the makers of Claritin.

Sullivan P, et al. The effect of Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy. The American Journal of Managed Care 11:374-382, 2005.

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