Managing Access to Dextromethorphan: Cost Implications of a Potential Over-the-Counter to Prescription-Only Conversion

Executive Summary

There are approximately one billion cases of the common cold each year in the U.S. Adults average two to three colds per year, and children average even more. Not surprisingly, coughs and colds are the most common illness in humans. While a cold usually clears up within seven to ten days, its symptoms can be disruptive. Treatment options include a variety of over-the-counter (“OTC”) and prescription (“Rx”) medications. However, more than half of patients purchase nonprescription (OTC) drugs.5 From mid-2014 to mid-2015, patients spent about $2 billion per year on OTC drugs to treat their cough symptoms.

The majority of OTC cough medicines contain an active ingredient called dextromethorphan (“DXM”). DXM is the preferred OTC cough medication but is also subject to abuse by minors, which has raised concerns among policy-makers. In response to this, 12 states currently prohibit the sale of DXM OTC medicines to under-18 patients. Although the Food and Drug Administration (“FDA”) considered scheduling DXM as a controlled substance, an FDA advisory committee ultimately voted against this proposal due to the benefits of OTC access to DXM.

Government officials have tried to balance the positives of OTC access against the negatives of potential abuse. This paper aims to inform this discussion by quantifying various costs that would result if products with DXM were converted from OTC to Rx. Included are the costs of incremental physician visits, of having to miss work while going to the physician’s office, of higher DXM drugs prices under Rx availability, and of switching to alternative medication that may be more expensive. Based on a natural experiment of another OTC product that was converted to Rx status, prescription-only access to DXM would generate incremental costs between $21 and $31 billion for the period 2016 – 2025.