Of all the barriers to accessing essential medicines, policymakers too often overlook those the government itself imposes: unnecessary prescription requirements.

It might seem that giving government the power to require prescriptions would protect consumers by requiring them to consult with physicians before using dangerous drugs. In a new white paper for the Cato Institute, we argue government-imposed prescription requirements counter-intuitively make patients less safe rather than more.

One reason is, governments routinely use this power to block access to drugs that are safe for patients to use themselves. Consider:

• More than 100 countries, including communist China and Cuba, allow women to purchase oral contraceptives without a prescription. The American Council of Obstetricians and Gynecologists recommends eliminating prescription requirements for all hormonal contraceptives—a strong statement, considering its members profit from those requirements. Yet the United States and the United Kingdom stand with Saudi Arabia in requiring women to obtain prescriptions.


• The United States allows consumers to purchase some insulin products, and Canada allows consumers to purchase any insulin product, without a prescription. The United Kingdom requires prescriptions.


• Naloxone is a life-saving antidote to opioid overdoses with almost no side effects that should be available in vending machines and first-aid kits. Unlike Canada, which allows consumers to purchase naloxone directly from a pharmacist, both the United Kingdom and the United States require prescriptions.

During public health crises like COVID-19, government-imposed prescription requirements jeopardise access to medicines even more than usual. The British Pregnancy Advisory Service reported that women in the United Kingdom are “struggling to access contraception” because, “while [physicians] are supplying prescriptions, there is a long wait for telephone appointments which can mean that there is a gap during which they are not protected against unplanned pregnancy.” The American College of Obstetricians and Gynecologists writes, “COVID-19 response, including social distancing recommendations and delays to routine in‐​person visits, amplifies logistical obstacles to contraceptive initiation and continuation.”

Moreover, consumers appear to use riskier drugs when they come with a physician’s imprimatur. Economist Sam Peltzman found that mandatory prescription requirements led to a 50% increase in the consumption of more potent drugs. Consistent with Peltzman’s finding, a 2006 study found that women who self-screened for contraindications to oral contraceptives were more thorough than ob-gyns were.

In the aggregate, evidence suggests that mandatory prescription requirements either have zero effect or a harmful effect on consumer health. Peltzman found that after the U.S. government started imposing prescription requirements, deaths from accidental or suicidal poisonings did not fall but rather increased by 50-100%. In a subsequent international study, Peltzman found “no…statistically significant difference in infectious disease mortality between countries that enforce prescription requirements for antibiotics and those that do not.” In a second international study, he found “poisoning mortality is higher, all else remaining the same, in countries that enforce prescription regulation.”

In addition to the ways government-imposed prescription requirements harm consumers’ health, they also interfere with the freedom to make one’s own medical decisions. If a right to healthcare means anything, it is that competent adults have a right to purchase the medicines they need from a willing seller without the state standing in their way.

Fortunately, the United Kingdom appears to respect the right to self-medicate more than many other countries. In 2009, the U.S. government examined the prescription status of 86 drugs across Australia, Italy, the Netherlands, the United Kingdom, and the United States. Australia and the United Kingdom required prescriptions for just 23 of them. The United States, Italy, and Netherlands required prescriptions for 42, 43, and 45, respectively. Since 2009, the United Kingdom may have even gained ground on other countries.

When we examined the prescription status of seven medicines across 21 countries, though, the United Kingdom tied with France and four other countries in allowing non-prescription access to just three. That’s worse than Australia and Canada, which allow nonprescription access to four of the drugs, but better than the United States, which allows nonprescription access to just two.

Given the myth that the US healthcare sector is a free market, some might marvel that British consumers may have greater freedom to self-medicate than Americans. British migraine sufferers can buy sumatriptan without a prescription; that’s a freedom American migraine sufferers do not have. But the United Kingdom still requires prescriptions for medicines it should not, including insulin, naloxone, oral contraceptives, and the asthma medication salbutamol.

The UK government should eliminate mandatory prescription requirements. It should instead allow pharmaceutical manufacturers to decide which drugs should require prescriptions—and hold them liable if they market drugs in harmful ways. When the demos leaves these decisions to government, government routinely requires prescriptions for reasons other than safety. That is not healthy.

 

Michael F. Cannon is Director of Health Policy Studies at the Cato Institute. 

Jeffrey A. Singer is a Senior Fellow at the Cato Institute.

 

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Recommended reading:

• “Drug Reformation: End Government’s Power to Require Prescriptions” by Jeffrey A. Singer and Michael F. Cannon