Get Connected:


US Primary Care Providers' Use of Over-the-Counter Medications for Gastroesophageal Reflux Disease and Chronic Constipation

The perception and utilization of OTC medications among primary care providers for gastroesophageal reflux disease and chronic constipation shows a need for improved patient education on these medications.
Published Online: Jul 28,2017
Samuel W. Chey; William D. Chey, MD; Sameer D. Saini, MD; Arlene Weissman, PhD; Linda Harris; and Stacy B. Menees, MD

Objectives: Primary care providers (PCPs) treat the vast majority of gastroesophageal reflux (GERD) and chronic constipation (CC) patients in the United States. The aim of this study was to evaluate how PCPs perceive and utilize store brand and brand name OTC products for GERD and CC.

Methods: A 33-question survey was electronically sent to 622 eligible PCPs from the Internal Medicine Insider Research panel. The survey asked respondents about their usage of store brand and brand name OTCs for patients with GERD and CC, and requested their opinions about the quality, efficacy, safety, and price of these medications. Chi-square and students' t tests were utilized for bivariate analysis.

Results: A total of 337 PCPs (54% response rate) completed the survey. For the typical GERD and CC patient, 64% and 98% of PCPs utilized OTC medications for first-line treatment, respectively. Proton pump inhibitors (PPIs) were the most common OTC utilized for GERD (59%), while OTC fiber supplements (45%) were utilized most commonly for CC. The vast majority of PCPs felt that OTC store brand and brand name PPIs (79%) and polyethylene glycol (PEG) 3350 (87%) were equally effective. Despite this, only 24.7% of physicians have “some or extensive” discussion with patients about the use of store brand products in the treatment of their gastrointestinal disease. PCPs believed that store brand products were less expensive than brand name products, but more than 60% underestimated the cost savings (>20%) for both PPIs and PEG 3350. Few physicians had knowledge regarding the regulation of store brands.

Conclusions: For PCPs, OTC drugs are the cornerstone of treating GERD and CC patients. Though the majority of PCPs feel that store brand and brand name treatments offer similar effectiveness and reduced cost for GERD and CC patients, few discuss these points with their patients. Systematic efforts are needed to ensure that patients are better educated about low-cost treatment options for GERD and CC.

                                                                                            Am J Pharm Benefits. 2017;9(4):116-121

Gastroesophageal reflux (GERD) and chronic constipation (CC) are common gastrointestinal complaints seen by primary care providers (PCPs). GERD affects at least 20% of the US population and is the fourth most common chronic condition seen in primary care.1,2 Constipation affects 16% of all adults and 33% of adults 60 years or later.3 Both disorders have high direct medical costs, with GERD being the leader of all digestive diseases at $12.1 billion yearly.4 For both disorders, medications contribute significantly to these costs.4

For both GERD and CC, the medication landscape has changed significantly in the last 10 years. This is primarily due to the availability of OTC formulations— either generic or store brand (ie, Target-brand omeprazole or Walmart-brand PEG 3350) or brand name (ie, Prilosec or Miralax)—of drugs previously available only by prescription. Brand name and store brand OTC drugs each contain the same active ingredient, but differ in price. Third-party payers are increasingly refusing to initially cover the cost of high-tier prescription medications for “lifestyle conditions.” This forces patients with conditions like GERD and CC to purchase OTC options out of pocket, placing a premium on economic value in addition to efficacy.

 As PCPs see the most patients with GERD 5,6 and CC, 7 it is critical to understand their prescribing practices regarding prescription and OTC products in this era of cost consciousness. Therefore, the aim of this study was to assess how US PCPs perceive and utilize prescription as well as brand name and store brand OTC medications for GERD and CC, and to assess PCPs’ knowledge of the federal regulation of OTC medications. We hypothesized that US PCPs would be very familiar with and commonly recommend OTC medications for GERD and CC, but that they would have little knowledge of manufacturing, efficacy, and price differences between store brand OTC gastrointestinal medications and brand name alternatives.


Sample Population

After attaining exemption through the University of Michigan Medical School institutional review board, a nationally representative sample of US internists was surveyed in 2015. For our sampling frame, we utilized the American College of Physicians (ACP) Research Center’s Internal Medicine Insider Research panel, which is a representative group of ACP members who have voluntarily agreed to participate in periodic physician surveys.8 The eligible population consisted of 622 internists of the 1286 ACP members who are representative of the United States ACP membership across multiple demographic characteristics. Panelists who completed surveys were awarded $10 electronic gift cards. Information was not collected on nonresponders. To attain a 95% confidence level with a 5% margin of error for our results, we required a response from at least 244 of the 662 members.