4 ms·

Needs to go even further, and deregulate access to prescription drugs as well, to open up provider competition and increase consumer choice.

anythingnonidin 9y ago
What does this mean? Make all Rx drugs OTC?
- andrewfromx 9y ago
  I think we leave the Rx system as is, in that we still let pharmacists do their job and protect their mainstream normal patients and give good standard of care, but any party drugs where there is already a clandestine market become OTC. i.e. if you want some weird medicine for some weird thing that no one else wants, you'll have to go through the steps to get a Rx for it. But it won't be hard to get. Because once adderall is OTC there will be 1000's of freed up doctors who don't have to write Rx for that.
  - fujiters 9y ago
    I just wish we could do away with having to get the prescription in the first place and have the pharmacist be the gatekeeper. You keep a medical history on file so they can quickly figure out if the medication you want is likely to cause complications. Then I don't have to leave work and meet with my doctor every few weeks/months to get another prescription which I then have to take to the drug store and wait to get filled.
    - subroutine 9y ago
      Right now are you paying cash out-of-pocket or does your health insurance cover your Rx aside from ~ $10 copay?
    - vidarh 9y ago
      In the UK we now have at least three alternatives (other than "grey market" import; most prescription drugs outside of narcotics can be legally imported to the UK for personal use): For OTC drugs with restrictions, online pharmacies can sell subject to asking you sufficient questions (and potentially doing a followup call if you answers raises questions). This covers drugs like steroid creams and the like which may have risks, but are usually ok. For prescription drugs, online pharmacies can likewise sell to you if they have you fill in a questionnaire and a qualified GP agrees to write a prescription for you. This is increasingly done for low risk but prescription only drugs like Viagra. The mechanisms above are simple enough that even though buying from e.g. companies shipping from Indian manufacturers is trivial in the UK, I'll prefer UK online pharmacies when possible as the extra hassle is minimal and they're better regulated. Alternatively there's a service called Push Doctor (I've got no connection to them other than being a satisfied user) that lets you have an actual conversation with a doctor over a video chat (+ text chat and ability to upload images) after which they can issue you a prescription that gets sent electronically to the nearest pharmacy. I've tried it twice - once I got seen within an hour, the other time in less than 10 minutes, and the prescriptions were ready within half an hour in both cases, so I could just wait for a text message and go pick it up when it was ready. It's a fantastic service - the only downside is it's private only, and while the consultations aren't expensive (28 pounds or 20/month), for more expensive prescriptions it's not great as you'd be paying full price for the drugs (but you do have the option of e.g. use them for diagnosis and go see your GP to get an NHS prescription if they think you need anything expensive, so you at least avoid having to visit your GP for minor things); I'd love to see this service get a deal with the NHS... With the above setup there's very little reason to take risks as the barriers are low enough for most people to have very little reason to circumvent them. I do agree with you though that for most drugs delegating it to a pharmacist would probably provide a good enough barrier - at least in the UK, and I suspect most other places too, they're well educated. When it isn't we should ask why. E.g. are doctors looking for signs of any issues? If those issues are simple enough and there's low enough abuse potential, then either let pharmacists do it or standardize a questionnaire.
- amyjess 9y ago
  For the record, many Asian countries such as India and Thailand do this, and I understand that some European countries such as Spain have very liberal OTC policies. There are a few drugs like opioids that are controlled substances, but everything else is OTC.
keithnz 9y ago
I don't understand that line of argument? it's kind of like saying, lets deregulate the road / sky so we have increased choice of how and where we drive and who can fly aircraft and where...... more choice, more competition..... but clearly a bad idea because it is actually dangerous without regulation

anythingnonidin 9y ago

What does this mean? Make all Rx drugs OTC?

andrewfromx 9y ago
I think we leave the Rx system as is, in that we still let pharmacists do their job and protect their mainstream normal patients and give good standard of care, but any party drugs where there is already a clandestine market become OTC. i.e. if you want some weird medicine for some weird thing that no one else wants, you'll have to go through the steps to get a Rx for it. But it won't be hard to get. Because once adderall is OTC there will be 1000's of freed up doctors who don't have to write Rx for that.
- fujiters 9y ago
  I just wish we could do away with having to get the prescription in the first place and have the pharmacist be the gatekeeper. You keep a medical history on file so they can quickly figure out if the medication you want is likely to cause complications. Then I don't have to leave work and meet with my doctor every few weeks/months to get another prescription which I then have to take to the drug store and wait to get filled.
  - subroutine 9y ago
    Right now are you paying cash out-of-pocket or does your health insurance cover your Rx aside from ~ $10 copay?
  - vidarh 9y ago
    In the UK we now have at least three alternatives (other than "grey market" import; most prescription drugs outside of narcotics can be legally imported to the UK for personal use): For OTC drugs with restrictions, online pharmacies can sell subject to asking you sufficient questions (and potentially doing a followup call if you answers raises questions). This covers drugs like steroid creams and the like which may have risks, but are usually ok. For prescription drugs, online pharmacies can likewise sell to you if they have you fill in a questionnaire and a qualified GP agrees to write a prescription for you. This is increasingly done for low risk but prescription only drugs like Viagra. The mechanisms above are simple enough that even though buying from e.g. companies shipping from Indian manufacturers is trivial in the UK, I'll prefer UK online pharmacies when possible as the extra hassle is minimal and they're better regulated. Alternatively there's a service called Push Doctor (I've got no connection to them other than being a satisfied user) that lets you have an actual conversation with a doctor over a video chat (+ text chat and ability to upload images) after which they can issue you a prescription that gets sent electronically to the nearest pharmacy. I've tried it twice - once I got seen within an hour, the other time in less than 10 minutes, and the prescriptions were ready within half an hour in both cases, so I could just wait for a text message and go pick it up when it was ready. It's a fantastic service - the only downside is it's private only, and while the consultations aren't expensive (28 pounds or 20/month), for more expensive prescriptions it's not great as you'd be paying full price for the drugs (but you do have the option of e.g. use them for diagnosis and go see your GP to get an NHS prescription if they think you need anything expensive, so you at least avoid having to visit your GP for minor things); I'd love to see this service get a deal with the NHS... With the above setup there's very little reason to take risks as the barriers are low enough for most people to have very little reason to circumvent them. I do agree with you though that for most drugs delegating it to a pharmacist would probably provide a good enough barrier - at least in the UK, and I suspect most other places too, they're well educated. When it isn't we should ask why. E.g. are doctors looking for signs of any issues? If those issues are simple enough and there's low enough abuse potential, then either let pharmacists do it or standardize a questionnaire.
amyjess 9y ago
For the record, many Asian countries such as India and Thailand do this, and I understand that some European countries such as Spain have very liberal OTC policies. There are a few drugs like opioids that are controlled substances, but everything else is OTC.

keithnz 9y ago

I don't understand that line of argument? it's kind of like saying, lets deregulate the road / sky so we have increased choice of how and where we drive and who can fly aircraft and where...... more choice, more competition..... but clearly a bad idea because it is actually dangerous without regulation