Prescription to Over-the-Counter Switch of Second-Generation Antihistamines (Loratadine): A Review of Its Impact on Healthcare Costs and Resource Utilization

The over-the-counter (OTC) conversion of loratadine was approved in the US in December 2002 for the treatment of allergic rhinitis, representing the first second-generation antihistamine (SGA) to be made available as an OTC product. This review examines the current evidence regarding the impact of this conversion on healthcare resource utilization and costs. Simulated decision models represent the majority of the research conducted in this area and appear to suggest that the availability of OTC loratadine reduces patient cost sharing, health-plan costs, and motor-vehicle accidents, and also improves work-related productivity. Other empirical research examining the policies adopted by health plans in response to the availability of OTC loratadine suggests that restricting access to prescription SGAs by placing these products in the third tier, thereby encouraging patients to purchase OTC loratadine, results in the greatest reduction in pharmacy-related costs for SGAs. However, early evaluations of such policies using health-plan data for the year 2003 show mixed results. Initial conclusions suggest that OTC loratadine has the potential to function as a safer treatment alternative to the sedating first-generation antihistamines in the treatment of allergic rhinitis. What is unclear is the impact of OTC loratadine on overall healthcare costs, as patients may choose the convenience of an OTC alternative to manage their allergic rhinitis in lieu of physician-supervised care. Further research is needed to examine if patients are unable to correctly diagnose their allergic rhinitis symptoms, which could potentially mask other chronic conditions and result in increased healthcare utilization and associated expenditures.