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In the US, prescription and OTC are theoretically completely unrelated, but in practice patent holders want their drugs to be prescription, where end users aren't involved in the process of selecting or paying for the drug, whereas generic manufacturers want the drugs to be OTC, where end users are choosing the product in a competitive market.

See, for example, Prilosec (Omeprazole) switching from prescription to OTC.

The FDA (or equivalent in the relevant country) regulates whether an approved drug requires a prescription based on the safety profile. To be approved for OTC, there is a much higher bar in terms of ease of misuse, side effects, and so on.

They don’t require one in the UAE (in practice, anyway), which has a well-regulated med scene.