Pharmacists may notice that some OTCs they stock in their pharmacies are now appearing on the rotating coils inside an increasing number of vending machines alongside chips and crackers. Late last year, Maryland lifted its decades-old ban on the sale of OTCs in vending machines, leaving Connecticut, Wisconsin, and Oklahoma as the only 3 states that continue to uphold such bans. This additional access point to pain relievers, allergy meds, and contraception may not change the landscape for pharmacy and pharmacy practice, but it will add to a landscape in which access to both medication and health care in general has been increasing. “The pandemic has proved to us that health care is changing, and pharmacy is a part of health care,” said Stefanie Ferreri, PharmD, professor and chair of the division of practice advancement and clinical education at University of North Carolina’s Eshelman School of Pharmacy. “We are rethinking how health care is delivered, and that includes how medications get to patients.” There’s no federal law that prohibits the sale of OTC medications in vending machines, but many states have banned the practice over the last 50 years or so. During this time, however, consumers have had many points of access to OTC products outside of the pharmacy, including grocery stores, gas stations, corner stores, and more recently the Internet. “I don’t see this changing the landscape,” said Lisa Kroon, PharmD, professor of clinical pharmacy and department chair at the University of California, San Francisco School of Pharmacy. Instead, vending machines that carry OTC products add to an environment where access to medication and to health care in general has been increasing. The machines join home delivery, curbside pickup, and mail order pharmacy, among other new modes of medication delivery. In this current pandemic and flu season, vending machines may offer the added advantage of cutting down on unnecessary foot traffic at brick-and-mortar stores. “The convenience of it is certainly a big advantage,” Ferreri said. In some parts of the country, this kind of access may provide a greater advantage than in others. In a February 2021 report urging Maryland lawmakers to lift the ban on vending machine sales of OTC drugs, bill sponsor Robbyn Lewis (D-Baltimore) pointed out that many people live in pharmacy deserts. As for those who live near a pharmacy, only 5% of those stores are open 24 hours. But in these remote areas, one should ask how often vending machine products turn over or get restocked, Kroon noted. “How long are these medications just sitting in there? Who’s checking expiration dates? Even at a corner store, you’d think turnover would be a little higher,” she said What’s more, while pharmacy deserts tend to be found in low-income areas, vending machines may not provide affordable access to OTC medication. “You’re not going to get the choice of the store brand in a vending machine, and those are a whole lot cheaper,” Kroon said. While the machines may dispense pain, cold, and allergy relief medications, they cannot dispense a pharmacist’s advice. Though they only stock OTCs, many consumers are unaware that these types of products could cause interactions with their prescription medications or could interact with existing health conditions. “A pharmacist is a great health care professional for advice on over-the-counter medicines,” Ferrari says. “In fact, we’re the only health care professionals trained in over-the-counter medicines. So that’s a big disadvantage of these vending machines.” But pharmacists still have the opportunity to dispense advice on OTCs after vending machine sales. The sale of OTC drugs in vending machines simply underscores the need for pharmacists to inquire about OTCs and supplements when patients pick up prescriptions, if possible, and certainly during medication reviews. “You as the pharmacist may need to tell them about those OTC medications and the possible risks, since many patients assume they are always safe since you don’t need a prescription,” Ferreri said. “I usually have to ask the question in 2 or 3 different ways before I find out that they’e taking several over-the-counter medicines. So make sure that you ask and double-ask your patients what they’re taking.”
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