Presentation (CTI)

OBJECTIVES: Over-the-counter equivalent drugs (OTCEDs) refer to medications that are covered by health insurance but have the same ingredients as those available for purchase over the counter. Although OTCEDs can be purchased at pharmacies, as the patients only need to pay the copayment portion, many patients visit doctors to obtain OTCEDs. As the health insurance system is fundamentally designed to support medical care that is necessary and financially burdensome for individuals, some people claim that OTCEDs should be excluded from the coverage. On the other hand, other people think that excluding OTCEDs from the coverage would simply lead physicians to prescribe more expensive medications instead, ultimately increasing overall healthcare costs. To assess the significance of these debates, we calculated the proportion of healthcare expenditures attributable to OTCEDs.
METHODS: Using the “Wellness-Star☆” database, the number of prescriptions, the number of days supplied, and healthcare expenditures related to OTCEDs per person per year, stratified by age and gender, were calculated. The database is a health insurance claims database compiled by Nippon Life Insurance Company from approximately 200 health insurance societies.
RESULTS: In CY2021, the number of prescriptions, the number of days supplied, and healthcare expenditures related to OTCEDs per person per year were 5.0 times, 34.5 days, and €8.84 respectively. About 0.84% of the total cost was attributable to OTCEDs. OTCEDs were relatively frequently prescribed to young children and the elderly.
CONCLUSIONS: The cost of OTCEDs accounted for just under 1% of total healthcare expenditures, which is not insignificant. Since health insurance societies are employer-based and younger, this proportion is likely to be even higher at the national level. Given the importance of the OTCED issue, it is necessary to develop a more sophisticated model for a simulation.