What Medications Are Kept Behind the Pharmacy Counter?

You probably already know that you need a prescription from your healthcare provider to get certain medications. And others are available over-the-counter (OTC) without a prescription. But you may not know about an unofficial third group of medications. They’re called behind-the-counter (BTC) medications. 

There are a handful of medications that fall into this group. But what makes them different from other medications? Here we’ll cover three different medications that you can find behind the counter.

What does it mean when a drug is ‘behind the counter?’

You can buy BTC medications without a prescription from your healthcare provider. Sounds like OTC medications, right? The difference is that they’re kept behind the pharmacy counter. And before buying them, you need to talk to a pharmacy employee. 

These medications are behind the counter for different reasons. Some are kept there for safety purposes. That’s because they can cause harm if they aren’t used exactly as directed (like insulin). Other medications are behind the counter because they carry a risk of misuse or dependency. And in other cases, they can be used illegally to make highly addictive drugs.

These aren’t the only differences between OTC and BTC medications. And there are differences from prescription medications, too. We’ve summarized a few other differences below.

What common medications are behind the counter?

The number of BTC medications has gone down over the years. For example, emergency contraception used to be behind the counter. Now, it’s usually available to everyone without restriction as an OTC medication. But what medications are still behind the counter?

Pseudoephedrine

Pseudoephedrine (Sudafed) is a medication used to treat nasal and sinus congestion. You can find it in many cold medications, like Advil Cold and Sinus. It’s also available in combination with allergy medications in products like Allegra-D or Claritin-D.

In 2006, the FDA changed the rule for the sale of pseudoephedrine. The new rule required it to be placed behind the pharmacy counter. This change happened because pseudoephedrine can be used to make illegal methamphetamine. Methamphetamine (“meth”) is a stimulant that carries a high risk of abuse and dependency. 

You can buy up to 3.6 grams of pseudoephedrine per day and 9 grams per month. That amount can change depending on your state regulations. For example, Indiana and Oklahoma only allow 7.2 grams per month. Ask your pharmacist if you aren’t sure about your state rules. They can also tell you how much pseudoephedrine your medication contains.

You have to be at least 18 years old to buy pseudoephedrine. The pharmacist will ask you for a photo ID. They’ll enter your information and your purchase details into their electronic system. 

If you live in Oregon or Mississippi, you’ll need a prescription to buy pseudoephedrine. These states, along with a few others, consider it to be a controlled substance. Controlled substances are medications that carry a risk of abuse and/or dependency. You’ll also need a prescription if you live in certain areas of Missouri or Tennessee. More states are expected to make it prescription-only in the future, too.

If you’d rather buy a different nasal decongestant to help manage your cold symptoms, several OTC alternatives are available (like phenylephrine). Your pharmacist can help you navigate your options. 

Codeine-containing cough syrup

Other cold treatments you can find BTC in some states are cough syrups that contain codeine. Codeine is an opioid medication that helps treat pain. It’s also combined with other medicines, like guaifenesin or promethazine, to treat a cough.

Codeine-containing cough syrups are schedule 5 controlled substances. Schedule 5 medications have the lowest risk of abuse and/or dependency.

In most states, you need to have a prescription to buy these cough syrups. Some states allow you to buy them without prescription. Examples include Florida and Oklahoma. But you may need to be 18 years or older and present a photo ID.

If you’re unsure if you can buy codeine-containing cough syrup where you live, the easiest way to check is to ask your local pharmacist. 

OTC insulin

Another medication that few people know is available without prescription is insulin. You can buy two types of insulins without a prescription: insulin regular (e.g., Humulin R) and NPH (e.g., Novolin N). You can also find Novolin sold as ReliOn. However, ReliOn NovoLog (insulin aspart) requires a prescription.

You can also buy premixed insulin, which combines insulin regular (short-acting) and NPH (intermediate-acting) insulins (e.g., Humulin 70/30). 

Regular and NPH insulins are called human insulins. They're available BTC because of legislation that was passed in 1951. This was the year that prescription and OTC medications were split into separate groups. Human insulin wasn't named as a prescription medication. As a result, you can buy these products without a prescription everywhere in the U.S., except in the state of Indiana.

Insulin can have serious side effects if used incorrectly. For that reason, insulins you can buy without a prescription are kept behind the counter. This is to make sure that when you buy insulin, your pharmacist can counsel you on how to use it correctly.

Human insulin can be cheaper and you don't need a prescription to get it. This may make it a more convenient option for certain people. But, you should always talk to a healthcare provider before changing insulins if you’re currently using another type of insulin. 

Research has shown that when used appropriately, human insulin can help people manage their blood sugar successfully. But each insulin works differently. And your healthcare provider can help you adjust your insulin dose safely to avoid serious side effects. These include severe hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar).