In the U.S., most nonprescription drugs are available over-the-counter in pharmacies and other stores. Experts have suggested that drug availability could be increased by establishing an additional class of nonprescription drugs that would be held behind the counter (BTC) but would require the intervention of a pharmacist before being dispensed; a similar class of drugs exists in many other countries. This is a report on: (1) arguments supporting and opposing a U.S. BTC drug class; (2) changes in drug availability in 5 countries and the impact of restricted nonprescription classes on availability; and (3) issues important to the establishment of a BTC drug class. The author studied 5 countries: Australia, Italy, the Netherlands, the U.K., and the U.S.