# A Good Place to Start Trump’s New Health Care Plan: More Drugs Over the Counter Drugs almost always become much cheaper once they can be sold over the counter. February 12, 2026 • Commentary By [Jeffrey A. Singer](https://www.cato.org/people/jeffrey-singer) This article appeared in [*The Hill (Online)*](https://thehill.com/) on February 12, 2026. Watching a TV commercial for [Primatene Mist](https://www.primatene.com/) — the over-the-counter inhaler that uses epinephrine (adrenaline) to treat asthma attacks — I found myself wondering why people with asthma can buy that drug but not albuterol. It’s a question that goes straight to the heart of President Trump’s “[Great Healthcare Plan](https://www.whitehouse.gov/wp-content/uploads/2026/01/The-Great-Healthcare-Plan.pdf).” Epinephrine is a blunt instrument. It stimulates the heart and blood vessels and can raise blood pressure and heart rate. Albuterol, [in contrast](https://www.wellrx.com/news/epinephrine-inhaler-vs-albuterol/), is more targeted. It acts mainly on the bronchial system and has fewer effects elsewhere in the body. Yet in the U.S., the cruder drug is available over the counter, whereas the cleaner one is locked behind a prescription. In [much of the world](https://link.springer.com/article/10.1186/s40545-023-00627-z) — including [Australia](https://asthma.org.au/blog/accessing-salbutamol-without-prescription/), South Africa and large parts of Latin America — patients can buy albuterol without a prescription. That makes albuterol a clear starting point if Trump is serious about his recent promise in the “Great Healthcare Plan” to “make more verified safe pharmaceutical drugs available for over-the-counter purchase.” Drugs almost always become much cheaper once they can be sold over the counter. This is far from the only example. The Food and Drug Administration is full of rules that keep safer drugs prescription-only while allowing more dangerous ones to be sold over the counter. For years, the FDA let Americans buy [first-generation antihistamines](https://www.cato.org/white-paper/drug-reformation-end-governments-power-require-prescriptions#undermining-safety-case-antihistamines) such as Benadryl-OTC — even though these drugs cause sedation, impair driving, and have been linked to accidents and deaths. Meanwhile, the agency requires prescriptions for newer, far safer alternatives. Second-generation antihistamines such as Claritin, Zyrtec and Allegra don’t meaningfully sedate and have exceptionally clean safety records. Yet after approving them in the 1990s, the FDA spent years unintentionally steering patients toward the more dangerous drugs by keeping the safer ones prescription-only. An FDA advisory panel voted in 2001 to make the switch, but the agency delayed for years before finally allowing Claritin over the counter in 2002, Zyrtec in 2007 and Allegra in 2011. As one allergy specialist [put it at the time](https://www.cato.org/white-paper/drug-reformation-end-governments-power-require-prescriptions), “The over-the-counter medicines are much more dangerous than the ones we write the prescriptions for.” Another example is birth control pills. For years, the [American College of Obstetrics and Gynecology](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception), the [American Academy of Family Practice](https://www.aafp.org/about/policies/all/otc-oral-contraceptives.html), the [American Medical Association](https://www.axios.com/2022/06/16/doctors-push-to-make-birth-control-available-without-prescription?utm_source=twitter&utm_medium=social&utm_campaign=editorial&utm_content=health-birthcontrol.), and [most reproductive health providers](https://www.whijournal.com/article/S1049-3867(15)00140-1/abstract) have urged the FDA to allow women to access them without a prescription. When even the experts paid to act as gatekeepers say the gate isn’t needed, regulators should listen. Women can buy birth control pills over the counter in [more than 100 countries](https://freethepill.org/otc-access-world-map), but it wasn’t until 2023 that the FDA approved access to [a single brand of a single type of birth control pill](https://reason.com/2023/07/14/all-birth-control-pills-not-just-one-should-be-over-the-counter/) — the so-called “mini-pill” — which has [strict restrictions](https://www.aafp.org/pubs/afp/issues/2000/1015/p1849.html), making it inconvenient for many women to use. HIV prophylactic drugs would work wonders to reduce the spread of the disease if the FDA allowed individuals [over-the-counter access](https://www.sfchronicle.com/opinion/openforum/article/FDA-should-make-anti-HIV-drug-over-the-counter-14833367.php). Although many states have created workarounds to the FDA’s prescription requirement by letting their [pharmacists prescribe](https://naspa.us/resource/pharmacist-prescribing-hiv-prep-and-pep/) the drugs, true over-the-counter availability — the ability to buy them off the shelf — would go further, enhancing privacy and reducing stigma. A host of other drugs are candidates for over-the-counter status. GLP-1s are not only helping people reduce the health risks associated with obesity, but they also hold great potential to help people with [substance use and compulsive disorders](https://www.realclearhealth.com/blog/2024/07/05/glp-1_agonists_a_new_hope_for_substance_use_disorders_1042583.html). If GLP-1s continue to live up to their promise, why shouldn’t people be able to buy them [over the counter](https://reason.com/2025/05/31/unlocking-the-full-potential-of-glp-1s/) to help themselves cut back on alcohol, cannabis or even harder drugs? That would let people cut back earlier, before problems become severe, on their own terms — without stigma, lectures or gatekeepers. Drugs [almost always become much cheaper](https://www.cato.org/white-paper/drug-reformation-end-governments-power-require-prescriptions) once they can be sold over the counter. The same painkillers that cost many times more when prescribed are sold over the counter for a fraction of the price, saving consumers tens of billions of dollars annually — not only on drugs but also on unnecessary doctor visits. That’s no accident: When patients pay directly, they shop around and prices drop; when insurers pay, nobody cares what anything costs. Economist Sam Peltzman has [suggested](https://www.cato.org/regulation/spring-2018/prescription-lower-drug-prices-more-otc-transitions) a way to speed up the shift from prescription to over-the-counter: reverse the burden of proof. Once a drug has been used by millions over years with a safety record similar to well-known over-the-counter drugs such as ibuprofen, it should be automatically considered eligible for over-the-counter sale. Manufacturers wouldn’t need to ask the FDA for approval. Instead, the FDA would have to justify why the drug should not be non-prescription. Congress could also adopt [international drug reciprocity](https://repository.law.miami.edu/cgi/viewcontent.cgi?article=1288&context=umblr), letting Americans buy drugs over the counter that are already available on those terms in trusted countries such as Australia, Canada and the U.K. The FDA wouldn’t disappear; drugs would still state “Not FDA Approved” on their labels, but they would lose their [monopoly](https://www.cato.org/blog/who-deserves-cure-fdas-new-gatekeeping-game), and that competition would spur better, faster decisions and more innovation in drug safety. Trump has put the right principle on the table: More safe drugs should be available over the counter. Applying that principle — starting with obvious cases like the safer asthma inhaler — would be a modest but meaningful step, and a sign that the “Great Healthcare Plan” is about modernizing access to medicine rather than preserving outdated rules. ##### About the Author [![jeff-singer-cropped.jpg](/sites/cato.org/files/styles/author_picture/public/2024-05/jeff-singer-cropped.jpg?itok=G_0nEnx7)](/people/jeffrey-singer) ##### [Jeffrey A. Singer](/people/jeffrey-singer) Senior Fellow, Cato Institute [ ](https://x.com/dr4liberty) [ ](mailto:jsinger@cato.org)