Lowering Healthcare Costs Through Faster Access to OTC Medicines

 While debate over President Trump’s “Great Healthcare Plan” has focused heavily on the Most Favored Nation (MFN) drug pricing policy, another provision with additional and real potential to quickly lower costs has received far less attention: expanding access to over the counter (OTC) medicines.

Allowing more medications to be sold without a prescription would reduce costs, expand competition increase convenience, and ease pressure on the entire healthcare system. Done properly, expanding OTC access can deliver immediate, tangible benefits to patients by making medicines more affordable.

We’ve seen this story before. Over the past several decades, dozens of drugs have successfully moved from prescription-only status to local store shelves—transforming both access and affordability. Patients with chronic heartburn turned to Nexium and Prilosec without a doctor’s visit. Everyday pain relief became simpler with products like Aleve. Even cough suppression—through the approval of dextromethorphan (DXM)—shifted to OTC, enabling familiar brands like Mucinex, Robitussin, and NyQuil to become cheaper, more effective and available.

These switches did more than create convenience. They reduced unnecessary doctor visits, lowered out-of-pocket costs, and gave patients more control over routine care. What was once locked behind the pharmacy counter became accessible, affordable, and widely used.  And as more companies produced these products, it spurred economic competition, which lowered prices to consumers, making these medicines more affordable.

Expanding OTC access further would build on this proven track record. Improving the process of moving medicines from prescriptions to OTC is a major priority for the Trump Administration – as evidenced by the inclusion of this policy in the President’s Great Healthcare Plan.  It’s also an idea that should produce enthusiastic support on Capitol Hill among those who want to improve affordability. Each additional switch has the potential to generate meaningful savings and greater patient benefits.

Another reason for quick action is the U.S. lags other high-income countries in converting prescription medications to OTC.  In an analysis of 19 drugs with the same active ingredients, the U.S. had only two prescriptions to OTC approvals compared to nine in the UK, eight in Australia, and five in Germany and New Zealand.[1]

The economic case is substantial as significant savings stem from lower drug prices and fewer physician visits for routine conditions. A February 2025 study in the journal Health Economics found that removing the requirement that patients receive a prescription to purchase brand-name drugs reduced the retail price by more than 35% within five years, on average. A 2024 Journal of the American Medical Association study estimated 57% savings if Medicare Part D claims for 19 drugs identified with OTC equivalents had been paid at cash rather than pharmacy transaction prices. [2]

Patients see the most immediate benefit. OTC availability typically lowers per-dose costs and eliminates the time and expense of scheduling doctor visits. Studies consistently show that OTC use reduces unnecessary office appointments for common conditions like allergies, heartburn, and minor pain—freeing providers to focus on more complex care.

Employers and public programs benefit as well. Fewer claims for doctor visits and prescription drugs translate into lower overall spending, particularly for chronic but manageable conditions that benefit from these medications. At the same time, easier access can improve adherence, encouraging patients to treat symptoms earlier and more consistently—often preventing more costly complications later.

These transitions generally follow a New Drug Application (NDA) process or a Switch Petition, where the pharmaceutical company submits evidence to the FDA that the drug is safe, effective, and can be used by the public without professional supervision. The FDA reviews clinical trials, expert recommendations, and data about potential misuse or safety concerns before approving the switch.

The OTC provision in the Great Healthcare Plan[3] provides a strong policy mandate to the FDA to modernize and streamline the process for transitioning appropriate prescription drugs to over-the-counter availability. It directs the FDA to create a faster process to increase the availability of ‘over-the-counter’ safe medicines to patients without the time, money, and hassle of needing to receive a prescription. This would both lower prices and make it easier for people to quickly get the medicine they need.

Not every drug belongs on the shelf. Safety must remain the threshold. But the evidence is clear: when regulators make careful, evidence-based decisions, prescription-to-OTC switches consistently deliver consumer, economic, and public health gains.

Lawmakers should build on these successes—and make expanding OTC access a central part of their efforts to lower healthcare costs. By directing the FDA to create a clear, accelerated pathway to move more medicines to over-the-counter use, Congress can deliver on the President’s vision in the Great Healthcare Plan by elevating a provision that is not only practical, not only proven, but for too long has been overlooked and underemphasized in Washington at the expense of Americans.

Gary Andres is Assistant Secretary for Legislation at the U.S. Department of Health and Human Services.

https://www.realclearhealth.com/articles/2026/04/27/lowering_healthcare_costs_through_faster_access_to_otc_medicines_1179211.html