Over the counter Zantac used for acid reflux and heartburn.

Answer

You're correct that Zantac (ranitidine) is manufactured as both capsules and tablets (it is also available as a syrup and effervescent tablets).

There is no significant pharmacokinetic difference between either dosage form...they both work the same way and have the same rate and extent of absorption.

You really shouldn't notice a difference in effect between either. They will both be equally effective.

In terms of why your insurance will only pay for the capsules, ranitidine is one of those odd drugs where it is available both over the counter ('OTC') and by prescription ('Rx').

Ranitidine capsules are only available by prescription and you can't get them over the counter.

Ranitidine tablets are available over the counter and by prescription, depending on the strength. I summarize this below:

  • Ranitidine 150mg capsules (prescription only)
  • Ranitidine 300 mg capsules (prescription only)
  • Ranitidine 75 mg tablets (over the counter)
  • Ranitidine 150 mg tablets (prescription and over the counter)
  • Ranitidine 300 mg tablets (prescription only)

The vast majority of insurance plans do not pay for over the counter drugs. Some insurances may (including Medicaid programs), but most private insurances do not.

So, the simple answer to why your insurance only covers capsules is because it is a prescription-only drug and they don't cover drugs that are also available over the counter (or have an over the counter alternative).

Some insurances may pay for ranitidine tablets in a prescription-strength (300 mg) but the capsules are likely the only version covered under your formulary. This could be for a variety of reasons including a reduced cost to the insurer or the fact that they see the capsules as not having an over the counter alternative.


H2 Blockers OTC And Rx

There are certainly a good number of example drugs that are available both by prescription and over the counter, including ibuprofen, naproxen, and omeprazole.

What is somewhat unusual with ranitidine (and for many drugs that are used for stomach acid-related problems) is that the same strength is available as an Rx and OTC.

There are a few reasons as to why this happens. First, these drugs were available on an Rx-only basis first and then were moved OTC.

In most cases, when this happens, prescription versions will no longer be made since insurances won't cover them.

This is what happened with many of the allergy medications, such as Zyrtec and Allegra.

After review by the FDA, it was determined that these drugs had a wide margin of safety, didn't require physician monitoring in many cases and it was relatively easy to self-diagnose an issue that would necessitate their use.

What's different about drugs like ranitidine and omeprazole is that while they can be used on an intermittent basis for minor ailments like heartburn and indigestion, they are widely used for more complicated matters that would require your doctor to monitor and follow-up with you.

For example, they are used for the treatment of GERD (gastroesophageal reflux disease) and ulcers. These are conditions that require diagnosis and careful monitoring with drug therapy.

Having ranitidine available as a prescription (and therefore covered by your insurance) means that your doctor is writing the prescriptions for you and is monitoring you appropriately.

For your information, in addition to ranitidine, below are the other H2-blockers available on the market:


Final Words

To reiterate the answer to your question, you should notice no difference between ranitidine tablets and capsules of the same strength.

The capsules certainly can be opened and sprinkled on food if need be, but again, have the same rate and extent of absorption as the tablets do.


Summary

  • There is no significant difference between ranitidine capsules and tablets in terms of their effect.
  • Ranitidine capsule are a 'prescription-only' item while the tablets are available by prescription and over the counter (in certain strengths).
  • Insurances typically only cover the capsules since they are available only as a prescription. Many insurances don't cover drugs with an over the counter alternative.

  • References
    1. Prescription to Over-the-Counter (OTC) Switch List. FDA
    2. FAQs About Rx-to-OTC Switch. CHPA
    3. Zantac Prescribing Information. AccessFDA
    4. Ranitidine Monograph. DailyMED
    5. Prescription to over-the-counter switches in the United States. PubMed