Over-the-Counter vs Prescription: When OTC Is the Smarter Move

Some prescription drugs have identical OTC versions at a fraction of the cost. Here's when switching to over-the-counter makes sense.

Some of the most commonly prescribed medications are also available over the counter — often in the same exact formulation and strength. If you're paying a prescription copay for something you could buy off the shelf for less, you're spending more than you need to.

Common Prescription-to-OTC Overlaps

Several widely prescribed drugs have identical OTC versions. Omeprazole (Prilosec) for acid reflux is available in 20 mg tablets over the counter — the same dose commonly prescribed. Cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) for allergies are all available OTC in prescription-strength doses. Naproxen sodium (Aleve) for pain is available OTC at 220 mg, close to the common prescription dose of 250 mg. And ibuprofen (Advil/Motrin) at 200 mg OTC can be taken in the same quantities as many prescription regimens.

In each case, the active ingredient is identical. The OTC version went through the same FDA approval process as the prescription version. The pill in the OTC box is the same pill the pharmacy puts in a bottle.

When Prescription Is Still Better

There are good reasons to keep certain medications on prescription even when an OTC version exists. Prescription fills count toward your insurance deductible and out-of-pocket maximum — OTC purchases don't. If you're approaching your deductible, keeping drugs on prescription might save you more later in the year. Higher doses may only be available by prescription (omeprazole 40 mg, for instance, isn't available OTC). And some prescription-only formulations offer extended-release or combination versions that have no OTC equivalent.

Insurance formularies sometimes cover certain OTC medications at lower cost than the retail OTC price — your plan may actually have a $0 copay for omeprazole as a prescription while the OTC version costs $8. Check before you switch.

How to Make the Switch

Talk to your doctor first. Even though OTC medications don't technically require a prescription to buy, your doctor should know if you're switching how you obtain a medication they prescribed. They can confirm the OTC version is appropriate for your condition and dosing needs, and they might adjust your treatment plan accordingly.

Ask your pharmacist which OTC products contain the exact same active ingredient and strength as your prescription. They can point you to the right product and confirm you're getting an equivalent dose. Store-brand generics of OTC drugs are almost always cheaper than name-brand OTC and contain identical ingredients.

Use your HSA or FSA to buy eligible OTC medications — this effectively gives you a tax discount on top of the lower price.