COVER STORY

UP FRONT AND CENTER

Exclusive Drug Topics survey finds that R.Ph.s are doing more OTC counseling these days

Pharmacists believe they counsel the same number of patients or more about over-the-counter items as they did a year ago. A comparison with figures from the last Drug Topics' OTC Recommendation Study conducted in 2000 reveals that R.Ph.s are counseling more patients today than they did three years ago.

Respondents to Drug Topics' 2003 OTC Recommendation Study said they counsel, on average, 48 patients on nonprescription medications in a typical week, compared with 38 patients per week in 2000.

Some respondents to the 2003 survey reported they are counseling more—one-fifth of them said they counsel as many as 60 or more patients per week. A pharmacist's gender, age, and location seem to make a difference in how much more they counsel today than they did a year ago. Almost half of pharmacists working in chain/supermarket/mass-merchandiser settings ("other"), 52% of female pharmacists, half of those practicing in the West, and 49% of pharmacists age 45 and under were more likely than their counterparts to report counseling more patients today than they did just one year ago.

Janet Engle, Pharm.D., associate dean for academic affairs and clinical associate professor of pharmacy practice at University of Illinois College of Pharmacy, was enthusiastic about this uptick in counseling. "There's been an explosion in nonprescription choices," she said. "Now that there are so many products going from Rx to OTC status, consumers need help wading through all of the choices. More and more consumers know pharmacists are accessible and can help them choose."

Jeanette Driscoll, president of Savvy Market Information, added, "Due to rising costs, many consumers no longer have healthcare coverage or basic hospitalization coverage. To reduce expenses, these patients are turning to OTC products instead of visiting a physician to get a prescription. However, they still need the advice of a medical professional to differentiate among the multitude of products available."

Who gets the dialogue rolling?

Customers are frequently opening up the dialogue with R.Ph.s about OTC products. On average, these powwows are initiated by customers 70% of the time; pharmacists take the lead only 30% of the time. More than one-third of pharmacists working in an independent pharmacy said they initiate the counseling session, whereas 28% of those working in all other settings strike up a conversation on OTCs.

When asked, Are there specific OTC product categories for which you are most likely to initiate the discussion? pharmacists listed a multitude of categories, including analgesics, antacids, antihistamines, calcium, cough and cold remedies, diabetes supplies, laxatives, and vitamins.

How do pharmacists select which OTCs to recommend? One pharmacist replied, "I ask questions such as if they tried a specific product before or if they have health conditions such as high blood pressure or gastric problems."

Another pharmacist responded, "If I've used it and it worked, I recommend it." Yet another respondent said recommendations are based on "clinical articles in pharmacy magazines and the retail price of products."

Several pharmacists keep their patients' wallets in mind. "If two products work equally well, I recommend the cheapest," was one response. Another R.Ph. said the product has to "be effective, have the least side effects, at a good price."

An unexpected finding in this year's survey is that OTCs are not making the cash register jingle incessantly, despite the fact that there are so many new ones on the market. Respondents reported that income generated by OTCs accounts for just 19% of their stores' annual gross revenues, on average. Chain, supermarket, and mass-merchandising pharmacies acknowledged they are raking in a higher gross revenue from OTCs (22%) than independent pharmacies (15%). However, 73% of pharmacists said revenue generated from OTCs has remained the same since last year, only 21% said the percentage has increased, and 6% said this amount has decreased since last year.

These findings came as no surprise to Tim Covington, director of the Managed Care Institute at McWhorter School of Pharmacy, Samford University, Birmingham, Ala. "Many pharmacists have tended to undervalue and trivialize nonprescription drug therapy and OTC consultation as a business and professional opportunity of great magnitude," he said. "This is, in part, evident in the OTC market share loss by pharmacy since 1970 [65% of OTC market in 1970 versus 36%-39% today]."

One finding that bodes well for pharmacists and patients is that state Medicaid programs are providing reimbursement for many OTCs. Sixty-three percent of pharmacists indicated that their state's Medicaid programs provide reimbursement for specific OTCs, while only 16% indicated that other patient insurance plans cover specific OTCs.

What classes of OTCs are state Medicaid programs or insurance companies covering? Respondents listed acetaminophen, allergy, analgesics, antacids, antihistamines, blood glucose test kits and strips, calcium, cough and cold products, head lice medication, laxatives, vitamins, stool softeners, and smoking-cessation products.

Yet another eye-opening finding from the 2003 survey concerned pharmacists' views on whether anticipated Rx-to-OTC switches will have a positive effect on their bottom line. Only about a quarter of respondents felt such switches would have a positive effect on their pharmacy's bottom line. Forty-two percent said Rx-to-OTC switches wouldn't have any effect, while 34% feel switches would have a negative effect.

These switches may soon have a positive effect on pharmacy's bottom line, judging from the following statistics cited by Covington: "Approximately 73% of consumers prefer to treat symptoms themselves with OTC medications. Approximately 79% of consumers believe Rx-to-OTC switched products save them money. More than 50% of consumers believe Rx-to-OTC switched products prevent some physician office visits."

Is R.Ph.s' advice followed?

A whopping 99% of pharmacists indicated that consumers frequently (88%) or sometimes (11%) heed their OTC recommendations.

Consumers in the West and Midwest appear to trust their R.Ph.s' OTC recommendations more frequently. Ninety-one percent of pharmacists in the West revealed that consumers stick by their OTC advice; 90% of pharmacists in the Midwest stated that their patients follow their OTC advice.

The 2003 survey included questions about whether pharmacists are recommending some of the newer OTCs and supplements on pharmacy shelves. For instance, Drug Topics asked, In an average month, do you recommend name-brand products in the pocket-sized oral care strips category to customers, either in your store or by telephone? Eighty-six percent of respondents said No; 14% said Yes. Specifically, respondents said they recommend name-brand products in this category an average of two times a month.

How about for popular supplements such as glucosamine/chondroitin? Almost a third of respondents recommend name-brand products in this category. More respondents in the East and Midwest are likely to recommend these supplements than R.Ph.s in other locales. Among those who make suggestions, the majority (85%) does so nine times a month.

Engle wasn't caught off guard by this finding. While she acknowledged that "in some cases, you can pick a brand that you know has good manufacturing practices, the problem with glucosamine/chondroitin is that even though there are studies that say it may be effective, the Food & Drug Administration doesn't regulate them. So when pharmacists recommend a product, they have no way of knowing if what's on the label is really inside the product."

One expected finding of the 2003 survey was that, with the conversion of Claritin (loratadine, Schering-Plough) to OTC status, many R.Ph.s are busy recommending name-brand products to customers in the nonsedating antihistamine category. Only one-quarter of respondents said they are not doing so, while more than three-quarters said they recommend name-brand products in this category on average 11 times per month. Of those who do recommend brands in this category, 87% recommend Claritin.

Commenting on this finding, Engle said, "There are many questions from consumers about allergy products because there's a lot of confusion. Statistics show more people are getting allergies. They are asking whether the products are safe, which products are safe for their children, and what the differences are between the products," she said.

Drug Topics also asked respondents, What would increase your level of confidence in making an OTC drug recommendation? The following factors were cited:

• More samples to try and to give away, personal experience

• More continuing education lessons on this topic, especially on herbs

• More time to discuss with patients

• No phony advertising

• Positive patient feedback

One pharmacist gave the following answer: "Knowing what other pharmacists recommend." Another respondent identified this as an issue: "Larger print size on the ingredients list." Still another pharmacist stated he would have more confidence in making OTC recommendations "if there weren't so many obviously useless products allowed by the FDA." Finally, a pharmacist suggested this strategy: "Having a flowchart that places OTCs in categories based on ingredients, not by brand name. Can't blame the customer for being confused by all the me-too OTCs that differ by the addition or lack of one ingredient."

Will pharmacists step up to the plate and take advantage of the clinical and economic opportunities that await them with the self-medicating consumer who wants and needs more and better information on OTCs? Covington wouldn't have it any other way. "The community pharmacist is the most appropriate human resource for initial contact by the self-medicating patient," he said. "In the realm of OTC drug therapy, the pharmacist can and should act as a gatekeeper and a primary care practitioner. When people need assistance with OTC issues, the pharmacist should seek to assist in diagnosing the patient's self-treatable condition and then 'prescribe' an OTC drug or drugs if appropriate."

Sandra Levy

Are state Medicaid programs covering OTCs?

Which brands do R.Ph.s recommend most often?

Below are the leading products that R.Ph.s recommend to their patients. Multiple products are listed when there is a tie.

Rx-to-OTC switches: What's the bottom line?

*Chain/supermarket/mass-merchandiser

Source: Drug Topics' 2003 OTC Recommendation Study

Program explores R.Ph.s' role in self-care services

The American Pharmacists Association is offering pharmacists a national certificate training program entitled OTC Advisor Pharmacy-Based Self-Care Services.

The program explores the pharmacist's role in providing self-care services to patients and presents information about self-care products and services as well as a review of nonprescription therapeutics and self-care counseling techniques.

The program is conducted in two parts: a Web-based pre-seminar self-study component and a one-day live training seminar. For more information, contact PJackson@APhAnet.org or call (202) 429-7510.

 

Sandra Levy. Cover Story: UP FRONT AND CENTER. Drug Topics Jun. 2, 2003;147:44.