Q&A: Pharmacist, Patient Impact of Rx-to-OTC Switches

Nalaxone and norgestrel (Opill) are 2 of the most notable prescription drugs to move toward over-the-counter (OTC) options, making access to these medications greater than ever before. However, despite the patient benefits already being realized from these Rx-to-OTC switches, the pharmacists’ role in patient care is gradually being transformed as more and more products become available without a provider’s written prescription.

“In many ways, pharmacists have been absolutely critical in making these transitions work in practice, really helping people understand potential risks and interactions, managing side effects, and just deciding when self-care is appropriate,” Alyssa Billingsley, PharmD, senior director of pharmacy content at GoodRx, told Drug Topics. “I think that Rx-to-OTC switches have only reinforced pharmacists’ role as a trusted source of guidance, especially as people are given more choices and more responsibility for their own care.”

Aside from enhancing the pharmacists’ role in the community, Rx-to-OTC switches can also introduce both challenges and opportunities in the front-end of a pharmacy’s business.

In part 2 of our interview series with Billingsley, she explored some of the recent switches in the past year, what they could mean for community pharmacists, and how more switches in the future can significantly impact pharmacy business sustainability.

READ MORE: Understanding the Criteria, Process for Rx-to-OTC Switches

Drug Topics: Among some of the drugs that have moved from prescription-only to OTC—including contraceptives, opioid-reversing agents, and more—how do you think some of the FDA’s recent Rx-to-OTC switches have benefitted patients across the country?

Alyssa Billingsley: With some of the most recent switches, I would say the biggest benefit we've seen is faster, more equitable access to care—really allowing people to act quickly and independently without having to deal with appointments, prescriptions, and other delays that you would otherwise encounter in accessing these products.

We saw that clearly with Opill in 2025, which became the first daily oral contraception available OTC. For the first time, people could start a reliable birth control pill immediately without seeing a provider. We have some early data that suggests that Opill is reaching people who weren't using contraception before, as well as those relying on less-effective methods like condoms. This is especially important for underserved populations, including people who may not have insurance. Maybe they live in rural areas, or they have just limited access to health care.

We've also seen this with opioid-reversing agents like Naloxone, which went OTC the same year as Opill. Moving Naloxone OTC has made it readily available, normalized its use, really increasing the chances that it's on-hand during an overdose, which can ultimately save lives.

Drug Topics: How have pharmacist’s roles evolved amid the history of Rx-to-OTC switches in the past 10 to 20 years?

Alyssa Billingsley: Over the past decade or 2, pharmacists’ roles have really evolved from primarily being dispensers of medications to really acting as clinical advisors and decision guides. As more medications have moved OTC, pharmacists are often the first point of contact when people are trying to decide whether a product is right for them.

In many ways, pharmacists have been absolutely critical in making these transitions work in practice, really helping people understand potential risks and interactions, managing side effects, and just deciding when self-care is appropriate. I think that Rx-to-OTC switches have only reinforced pharmacists’ role as a trusted source of guidance, especially as people are given more choices and more responsibility for their own care.

Drug Topics: How can instances of drugs going to OTC impact the financial sustainability of community pharmacies that dispense these products?

Alyssa Billingsley: I think that's a really important question, because yes, Rx-to-OTC switches increases access to certain medications, but they can also have a mixed financial impact on community pharmacies. On one hand, pharmacies may lose prescription volume and dispensing fees tied to insurance claims when a medication moves OTC. At the same time, OTC products often have higher front-end margins, and they can also just bring more people into the store, which can lead to additional purchases. But more importantly, they really create more opportunities for pharmacist engagement, helping patients choose the right product, understand safety considerations, and compare OTC and prescription options.

I would say that cost is often where these conversations can get somewhat tricky. OTC doesn't always mean lower cost, and patients may be surprised when insurance no longer applies in certain cases. I think pharmacists can play a key role in setting expectations early and helping patients understand their options. Having access to price transparency tools, such as GoodRx, can really help support these discussions and reduce some of that last-minute friction at the counter, which ultimately matters for long-term pharmacy sustainability.

READ MORE: OTC Resource Center

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