Q: What does the phrase “behind-the-counter” mean?
Medications that are stocked behind the pharmacy counter but are sold without a prescription from a doctor are often referred to as being “behind the counter”. In my career as a pharmacist, I’ve seen two types of medicines that fit this definition: those that require me to check the identification of someone purchasing it, and those that don’t require any ID.
Two non-prescription medicines that require ID are specially labeled bottles of cough syrup with codeine and anything containing pseudoephedrine. To reduce abuse and diversion of codeine and pseudoephedrine, there are restrictions on how much you can buy in a single purchase and also how much you can buy within a certain time period.
Small 4-ounce bottles of cough syrup with codeine can be sold without a prescription in Washington State, but many pharmacies stopped keeping them on hand because of the hassle of maintaining the registry of who purchased them. The extra time spent documenting each purchase wasn’t worth it. Also, Delsym® cough syrup is available without any restrictions, which works nearly as well and doesn’t cause the drowsiness that codeine often does.
Sudafed® PE and any combination allergy and cold medicine that contains psuedoephedrine as an ingredient requires showing ID when purchasing it in order to reduce easy access by those who use it to make methamphetamine. The Food and Drug Administration is considering restricting access to psuedoephedrine even further, from a non-prescription medicine to a prescription-only controlled substance like Vicodin® (hydrocodone/acetaminophen).
Medications that don’t require a prescription but are only available from a pharmacist include insulin syringes and some older types of insulin. Insulins that you can buy without a prescription include Novolin®-NPH, Novolin-R® and Novolin® 70/30. The newer insulins, such as Humalog®, Novolog®, Lantus® and Levemir® require a prescription.
One very old medicine called quinine used to be available from the pharmacist without a prescription, but the only form now available in the United States is the prescription form called Colcrys®.
Those of a certain age may remember when another type of product was only available “behind the counter”. After graduating from pharmacy school in the spring of 1979, I moved to Moses Lake, Washington working as a relief pharmacist at the Pay n’Save pharmacy every Wednesday from 3pm to 9pm and most Sundays from noon to 5pm. Because I looked young for my age, when seeing me behind the pharmacy counter for the first time many customer assumed I was a new clerk instead of the new pharmacist.
Customers would walk up to the pharmacy counter, see me, step back to look around, then ask me, “Is the pharmacist in?” Answering them, I’d say, “I’m your pharmacist tonight. How can I help you?” and watch their eyes widen in surprise.
Back then, I didn’t mind being a female pharmacist who looked barely old enough to drive, except for one thing: every time I worked, I kept losing money! Back then, condoms were kept “behind the counter” and every time I was the only pharmacist working I’d lose 2 out of every 3 condom sales.
It wasn’t that I wasn’t willing or able to sell them. In pharmacy school me and my classmates learned how to help a customer select just the right condom: lubricated or non-lubricated, reservoir tips or without, ribbed or smooth, latex or non-latex, flavored or colored. It made me feel bad to see guys walk toward the back of my store where our pharmacy counter was, look up and see me, stop, look around for another pharmacist and then turn around to walk right back out the front door without buying a thing. Sometimes they’d be striding back toward me only to glance up, see me by myself and make a quick U-turn back out the front door. “Drats, I just lost another sale!”
Later that year and thankfully before the store decided I was losing them too much money, the laws in Washington State changed to allow condom sales without restrictions. Halleluiah! After relocating the condom display to a side aisle, whenever I saw a man striding back to the pharmacy it was a relief to be able to catch his eye before he turned around and instead, smile and direct him to Aisle 19B.
