The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy

Background: Numerous prescription products have become available over the counter (OTC) in recent years. Previous simulation models have shown the Rx-to-OTC switch of loratadine to be cost effective. Objective: To empirically assess the overall effect of the Rx-to-OTC switch of loratadine and the specific effect of different pharmacy benefit structures on prescription drug utilization and cost among different plan sponsors. Methods: Data from a national pharmacy benefit management organization covering lives throughout the United States were used. The analysis included a comparison of the before and after change in prescription utilization and cost for plan sponsors that instituted 1 of 3 second-generation antihistamine (SGA) benefit responses: made no change, moved SGAs to the third tier, or restricted SGA benefits through a requirement for prior authorization. Multivariate regression analysis was used to control for differences across the study groups. Results: There was a substantial decrease in utilization and cost of all prescription drugs and combinations of drug classes. Patients with allergic rhinitis facing restricted prescription benefits for SGAs did not appear to increase utilization of other allergic rhinitis medications or other medications used to treat comorbid conditions such as asthma, sinusitis, and otitis media. Conclusions: Utilization and cost decreased substantially for all types of medications and all pharmacy benefit structures. Future studies need to examine the effect of the Rx-to-OTC switch of loratadine and resultant prescription benefit policies on medical utilization and OTC antihistamine utilization.