Behind-the-Counter Medications: What You Can Buy Without a Prescription (And What You Can't)

Ever walked into a pharmacy to buy Sudafed, only to find it locked behind the counter? Or tried to pick up Plan B at 11 p.m. and had to wait for the pharmacist to come out? You’re not alone. These aren’t random store policies-they’re part of a growing category called behind-the-counter (BTC) medications. Unlike regular over-the-counter (OTC) pills you can grab off a shelf, BTC drugs require a pharmacist to hand them to you. No prescription needed. But you do need ID, a conversation, and sometimes a wait.

What Exactly Are Behind-the-Counter Medications?

BTC medications sit between prescription drugs and regular OTC items. They’re not illegal. They’re not banned. But they’re not just sitting on a shelf either. The system was created in 2006 after Congress passed the Combat Methamphetamine Epidemic Act. The goal? Stop people from buying massive amounts of pseudoephedrine-the active ingredient in Sudafed-and turning it into methamphetamine.

Since then, the model has expanded. Now, it’s used for drugs that are safe and effective but need a little extra oversight. Pharmacists aren’t just cashiers here. They’re gatekeepers, advisors, and sometimes the only medical professional you’ll talk to before taking the medicine.

You can’t buy these at Walmart’s general merchandise aisle. You can’t order them online without a pharmacist verifying your identity. And you can’t walk out with more than the legal limit-even if you’re willing to pay extra.

Common BTC Medications You Can Buy Right Now

Here are the most common BTC medications you’ll actually find in U.S. pharmacies as of 2026:

• Pseudoephedrine (Sudafed, Claritin-D, Allegra-D): The original BTC drug. Each tablet usually contains 30-60 mg. You’re limited to 3.6 grams per day and 9 grams in 30 days. That’s about 6-12 tablets, depending on strength. You must show ID, and your purchase is logged in a national database called NPLEx, active in 45 states.
• Emergency Contraceptives (Plan B One-Step, Next Choice): Available without a prescription to anyone 17 and older. You still need to ask the pharmacist, and they must verify your age. These are 89% effective if taken within 72 hours of unprotected sex. Between 2007 and 2017, teen pregnancy rates dropped 46%-partly because Plan B became easier to get.
• Insulin (Walmart’s ReliOn brand): Regular insulin (Humulin R) and NPH insulin (Novolin N) are sold behind the counter for $25-$40 per vial. No prescription needed. This is a huge deal for people without insurance. Newer insulins like NovoLog still require a prescription.
• Codeine Cough Syrups (in a few states): Oregon and Mississippi still allow low-dose codeine (up to 12.8 mg per dose) without a prescription. But in most states, any codeine now requires a prescription due to abuse risks.

These aren’t random choices. Each one has a history of misuse, high effectiveness, or both. Pseudoephedrine helps with congestion but can be turned into a dangerous drug. Plan B prevents pregnancy but shouldn’t be used as regular birth control. Insulin saves lives but can be deadly if misused.

Why Not Just Make Them Fully OTC?

You might wonder: why not just let anyone buy these like aspirin? The answer is science.

Take pseudoephedrine versus phenylephrine. Both are decongestants. But pseudoephedrine works. A 2019 study in the Journal of Allergy and Clinical Immunology found it relieved congestion in 72% of users. Phenylephrine? Only 38%. So why is phenylephrine on the shelf and pseudoephedrine behind the counter? Because pseudoephedrine can be used to make meth. The trade-off: better relief, but more rules.

Same with Plan B. If it were fully OTC, minors could buy it without any oversight. The BTC model lets teens get it quickly-but still requires age verification. It’s not perfect. A 2022 Kaiser Health News investigation found 22% of pharmacies sold Plan B to underage teens without checking ID. But overall, access improved.

The Downsides: Inconvenience, Confusion, and Bias

BTC sounds good on paper. But in real life, it’s messy.

First, it’s inconvenient. You can’t just grab it while buying milk. You have to go into the pharmacy, wait for someone, show ID, answer questions, and get logged into a system. That’s 5-7 minutes of your time, every single time.

Second, rules vary by state. Oregon lets you buy 7.5 grams of pseudoephedrine a month. Texas lets you buy 9 grams. Some states require you to sign a logbook. Others use electronic systems. If you travel, you might get turned away because you hit your limit in another state.

Third, there’s bias. A 2021 University of Michigan study found Black customers were 3.2 times more likely to be questioned or refused when buying pseudoephedrine-even when their purchase patterns matched white customers exactly. That’s not about policy. That’s about perception.

And pharmacists aren’t always consistent. A 2022 study in the American Journal of Public Health found 18% of people seeking Plan B were delayed or denied-even though it’s legal. Some pharmacists refuse on moral grounds. Others just don’t know the rules.

What’s Changing? The Future of BTC

The BTC model isn’t standing still. In May 2023, the FDA approved LoRez, a low-dose naltrexone, as the first BTC medication for alcohol use disorder. That’s a big deal. It means medications for addiction-once strictly prescription-only-are now being reconsidered.

Industry experts predict 5-7 more prescription drugs will move to BTC status by 2027. Top candidates:

• Low-dose atorvastatin (for cholesterol)
• 150mg mifepristone (for gynecological conditions)
• Higher-dose epinephrine auto-injectors (for anaphylaxis)

Why? Because pharmacists are trained to spot drug interactions, side effects, and misuse. They’re often more accessible than doctors. And for conditions like high cholesterol or early-stage addiction, you don’t always need a full doctor visit-you just need someone to check if it’s safe for you.

The market is growing, too. BTC medications made up 3% of all OTC sales in 2023. That’s about $3.6 billion. By 2026, that number could hit $8.5 billion. Retailers like Walmart are betting on it-ReliOn insulin now controls 18% of the OTC insulin market.

What You Need to Know Before You Buy

If you’re planning to buy a BTC medication, here’s what to expect:

1. Bring ID-government-issued photo ID only. No student cards, no expired licenses.
2. Know your limits-pseudoephedrine is capped at 3.6g/day, 9g/month. Don’t try to buy from multiple stores. NPLEx tracks it all.
3. Ask questions-pharmacists are there to help. If you’re unsure about dosage, timing, or side effects, ask. 76% of people who get BTC meds say they feel more confident after talking to a pharmacist.
4. Check your state rules-some states have stricter limits. Look up your state’s pharmacy board website if you’re unsure.
5. Don’t assume it’s automatic-some pharmacists may hesitate, especially with Plan B or insulin. Know your rights. If you’re legally allowed to buy it, you should be able to.

For insulin buyers: Walmart’s ReliOn brand is the most affordable option. But make sure you’re getting the right type-regular or NPH. Don’t confuse it with fast-acting insulins like Humalog, which still need a prescription.

What’s Next?

The BTC model is here to stay. It’s not perfect, but it’s better than the alternatives. Fully OTC? Too risky for some drugs. Prescription-only? Too slow for urgent needs.

The real question isn’t whether BTC works. It’s whether we’ll fix the gaps. Standardize rules across states. Train pharmacists to reduce bias. Improve patient education. Make it easier for people in rural areas to access these drugs.

Until then, if you need pseudoephedrine, Plan B, or insulin-be prepared. Bring your ID. Know the rules. And don’t be afraid to ask for help. That’s what the pharmacist is there for.