The death of the corner pharmacy
As more customers choose – or are forced – to fill prescriptions by mail, independent pharmacies are struggling to survive. What do you think should be done?
From Dr. Paul Willis, Los Angeles, CA As a primary care physician, the amount of time required to complete forms, check formulary status and cross verify prescriptions from the PBM's only adds to my staff's chores. When an insurance company "requires" a patient utilize their PBM, I routinely suggest (strongly) that they fill their prescriptions at Walmart, where they aren't tracked. The result – insurances routinely send me "reminders" that their patients aren't filling their BP or COPD meds – because they pay cash for them & insurance can't track them. In addition, the patient doesn't have to wait for the mail to get their meds – FIGHT BACK!
From Tim K Canton,OH I own a pharmacy in NE Ohio. We are starting a battle with our school system who is sending tax dollars out of county and out of state to use a mail order service. How does it look in this poor economy to send business out of state? How could someone feel good voting for a tax levy when the money is going out of state? If we are asked to invest in our schools shouldn't our schools invest in the community?
From Steve K David I am surprised to read all these articles
From kula, Hawaii You are illustrating exactly the concerns. I had the same experience but the non-clinical person tried to pass himself off as a licensed pharmacist. He had a degree in business economics. No surprise there. I think these companies are being run by the same scumbags that were working on Wall Street and the Big banks. I see mail order pharmacies as increasing fragmentation of care. I don't see my physician faxing over anything to the mail order pharmacy that we in the State of Hawaii are being forced to use. There is not even a number to consult with a pharmacist with informedRx.
From Kula, Hawaii I as well as all the state employees of Hawaii are being forced to buy their maintenance meds for informedRx. The issues with using mail order for maintenance meds is the lack of the pharmacist being part of the team. I called the customer care line and asked what their background in pharmacy was. I was informed that this person had a degree in pharmacy. He finally admitted he had a degree in business economics but had trained for a few weeks for this job an felt he was qualified to discuss any concerns I had. I don't think many people understand that pharmacists have at least 8 years of education before then can practice. There is no number for pharmacy consult. Even the big boxes have a pharmacist to consult. I honestly think that this approach fragments care leading to increased drug interactions, side effects etc. I will not buy my meds from InformedRX the fact that their customer care staff lie to the patients I just can't trust them with my medications.
From Linda, FL I think most people would rather go to their neighborhood pharmacy, but it is the insurance companies who insist that we get prescriptions by mail. Insurance companies, be it car, home or medical are running this country into the ground.
From Brian St, Louis MO I am surprised to read all of these incidents. I have used Medco for years, I, along with my elderly mother use mail order which ends up with, on the average, orders of up to twenty-five mail orders combined being sent,every three months. I have had nothing but excellent results. The cost is lower, the fast delivery and the hassle of having to make numerous trips to Target makes it so convenient. I'm conscience of and sorry about the local pharmacy loss of business, but I would blame the Wall*Marts of the world for loss of not only all mom and pop pharmacies, but of all local established neighborhood businesses. I find it hard to believe that people are "forced" to use mail-order, especially for one-time prescriptions.How many people on this thread use cheap Wall*Mart for their non-prescription health related needs instead of making the trip to the local pharmacy?
From Jackie RN, Chattanooga, TN My family had to switch to Express-Scripts last summer. I am and insulin dependant diabetic and dealing with them has brought me to tears on several occaisions. My situation is compounded by a physician who refuses to communicate with them by fax. Hopefully something will be done to reign in these pharmacy's. Customer service is a joke with non-clinical personal discussing medications w/consumers.
From Jen, Chicago, IL I agree, it's sad. I am so glad I didn't end up going to pharmacy school a few years ago. I thought at the time that people will always need to have prescriptions filled so it was a good career move. Who ever know what the right job to take is anymore?
From Thomas Raleigh NC Because the medicine sold by drug manufacturers is sold based on end user (nursing home, hospital, mailorder, AARP, planned parenthood, retail pharmacy) the mailorder pharmacies are given a huge discount in what they pay for medicine. This discount the retail pharmacies have a hard time competing against. AARP is just as much a problem as the other mailorder pharmacies. If the retail pharmacies could get the break on medicine that the other classes of purchasers get not only would retail pharmacies be more competitive, but they would win on price. Why do the PBM's get a rebate and who pays for it? The retail pharmacy pays so others can get a break.
Level the playing field by charging based upon quantities of medicine sold. Buying groups would make the independants survive.
From John Russell The whole "Mail-order drug" thing is just one more giant scam.
From hogger, Willowbrook, Illinois Mail order has increased the price this year; they know you no longer can go to a local drug store.The service is not good but insurance force you to buy from them! What choice do you have?
From James, Harrisburg, PA Yeah, and pharmacists, like my father, are DAILY cleaning up your mistakes.
From Malachi Yoder I just had an unfortunate interaction with a mail order pharmacy. After 2 separate incidents that had me on the phone for a total of 7 hours, and 22 phone transfers, I finally got the situation resolved. They of course ask you over and over and over for the same information. Why don't they have folks that can read what I could only hope, is being recorded as I speak. Why do they take your phone number with never having any intent on following up with whatever the heck they do?The real problem is that you have a bunch of bean counters and phone clerks making decisions that should be done by a licensed pharmacist. These folks have no medical training, and aren't liable for 'life and death' screwups. What do you think your chances are of pinning the tail on one of these donkeys?How can it be cost effective to distribute 90 days of medication, when the patient may have a prescription change, or die? How many of the prescriptions are flushed down the drain? I know in many cases, the patient has 3 refills at the local RX and then must do the mail order deal. If you think this is a poor way to treat people, wait until you see how your treated if the congress votes for the socialized medical healthcare plan. Ask any Canadian why their doctors, researchers, and medical professionals no longer reside in Canada. If you've ever worked in a union shop on Monday morning or Friday afternoon, talk to your legislator about the healthcare bill.
From GC, Marlborough, MA Online pharmacies are just one more thing leading to job destruction in America.
From Dr. Phil Hopkins, Jr., RPh Mail order is a pricing scam on the part of the PBM's. Yes, a patient may receive a lower co-pay and obtain a 90 day supply, but the reality is that the price would be no differnt were they also allowed to obtain a bulk quantity of 90 days at an actual store; patients are limited to 30 days supply and one PBM actually makes the patient pay a co-pay every 21 days if they do not use mail order. And if the mail order copany makes a mistake, loses a the patient's prescriptions, fails to ship the medicaitons in a timely fashion, or sends the wrong ones, I, the actual store-based pharamcist have to then tackle the time comsuming tasks of obtaining an emergency supply prescription from the patient's physician office as quickly as possible and then calling the insuance company who screwed it all up to start with and obtain an emergency drug override so we can be paid for the medication we are dispensing to the patient who is often already out of it at this point. If any company, including my own told me I had to do mail order for my medications (thankfully, I take none at this point in my life) I would not hesitate to terminiate them and obtain my health insurance drug coverage elsewhere.
From John S. One criticism of PBMs that absolutely does NOT stand to reason is how much they charge for copays. That is determined completely by the benefit provider (company, union, group, etc.).
From Mary Ann Woodbury, Midland, MI Error in my prior submittal $990 should have read $990K or $990,000
From Mary Ann Woodbury, Midland, MI I absolutely would not use a PBM, if I had a choice. I far and away prefer a local unaffiliated small pharmacy. Unfortunately, I do not have sufficient income to purchase medications outright. I have switched my Mother out of Medco to a local independent pharmacy because I saw to it that she purchased insurance with that option.
For several years I have had the misfortune of being forced to use Medco Health Solutions for my maintenance medications. Forced because I have to pay triple at retail stores by my insurer's policies and make 3 separate trips. Typically the retail store has lower prices (full price) than what Medco has as full price. If the full price is higher at Medco, then Medco HAS NOT saved the insurance sponsor any money.
Medco has no customer service. I.e. service is so poor that it is equivalent to no service. You can never get problems resolved (I have been working for more than 3 months with more than 16 contacts on one problem which Medco caused.) They have lied to me and lied to my doctor. They are constantly in violation of state pharmaceutical practice laws. Their online system is dangerous as it allows customers to request expired drugs when they have a current script. Medco will take and fill as many scripts as are supplied for the same medication without questioning you or your physician. From what I see on the net, they are unethical, greedy and worthless. I must also mention their 2006 fine for $155 million for federal fraud and illegal kickbacks.
Maine and other states have passed laws to require transparency because of the practices of these companies. Has the consumer any chance? Not when these companies are spending as much as Medco spends: $990 a quarter (1st Q) in lobbying the U.S. government. (AP May 21, 2009) [Aside: just look at the mess that we ended up with on Medicare Part D as a result of the lobbying efforts of pharmaceutical companies and PBM’s]
I am really sorry for local pharmacies that have been so hurt by these companies.
From Bonnie, Levittown, PA I used mail order a few years ago and received the wrong pills. They told me they would re-ship the correct medication but I could not return the mistake nor would I be reimbursed for it either. Luckily, I can say it's not worth my time or energy to fight with them. I acquired new prescriptions, took them to a local pharmacy and I have not used mail order system since. I hope I am never forced to. It is worth the extra cost to know I'm getting the right medication and that I can discuss my concerns with the Pharmacist.
From joe, San Francisco, CA My father was a pharmacist who until he retired owned a pharmacy that had been in business since the depression. The small pharmacy has been dying for years. I know from working in my dad's pharmacy that people are mainly concerned with cost and convenience. The problem is I can't tell you how many times a patient came in and my father, knowing the patient and the doctor would catch a mistake (too high dosage, interactions, bad side effects) he would call the doctor to confirm and in many cases the doctor would make a new decision. In some cases the doctor (maybe a bad one) would stick by his guns – and if it were a very decision my dad would just not fill it.
I know the mail order joints have computer programs that determine interactions but nothing replaces a human professional who knows your medical history *and* the reputation of your doctor. Mail order is cheaper and to the customer the pharmacist is just a "pill counter" – until of course you take the wrong medication and suffer the consequences. The bottom line is that the quality of our medical care is on the decline.
From Irene, Johnstown, PA Are you getting what you pay for?? I was forced to use mail order when I was on Worker's Comp. I noticed that the Klonopin they sent was not the same. The pill was harder, and thicker although the same color, a slight difference no one would notice (but me). I contacted the manufacturer of Klonopin and sent them the pills for analysis. Shortly after, they began to manufacture the pill with a "K" stamped in the middle. In the interim, I called down to the place in Florida where I was forced to get my pills via mail order and in the course of the conversation, a young lady slipped up and said: "Oh, we have our own plant here where our pharmacists make our pills, so you know that what you get is o.k." I later heard about several "black market" pharmacies being raided.
Also, what if they send you the wrong script? You cannot readily take it back. You cannot converse with these people about drug interactions when you are on a lot of meds and get the cold or flu and are limited as to what you can take.
Insurance companies make agreements with various places. I now have to get my diabetic supplies from one place and my COPD meds from another place. So, how can meds be coordinated concerning interaction?
Remember we are granted a RIGHT to LIFE and Liberty and the Pursuit to happiness. These insurance companies are taking away your basic right to a good and safe life.
From Julie, Milpitas, CA I don't have much choice. There is so much greed in the Health and Pharma industries that I have to go where the prices are the cheapest in order to survive. The US has gotten to be a sad place with no bright future.
From Nancy, Chandler AZ For a time, Medco was charging a standard $25.00 per prescription, even when the actual cost was less. They only recently started charging the actual cost, which brought the cost of my maintenance medications down substantially, but for a while, it wasn't even worth it. Cheaper is cheaper, and while I support my local drugstore in other ways, I can no longer have my routine medications filled there. But they are still my first and only stop for non-routine medications, like flu shots, antibiotics, etc.
From Daniel, St. Louis Missouri Many people claim that the "Big 3" PBM's don't care but I work for one and can validate that we spend millions a year on customer service and are working effortlessly to increase customer satisfaction. We have automated techniques that ensure accuracy and numerous methods for the customer to fill their prescriptions. The entire business model is designed to make the customer happy. Many individuals who complain are the same individuals who can’t stand change; the industry is changing, evolving, whether society likes it or not. Mail order saves customers money, saves customers time and adheres to extremely strict compliance policies that are designed to keep the customer safe and ensure reliability and integrity of medication.
From Dan, New Providence, NJ Mail order pharmacies a penny wise and a pound foolish. They remove an important provider/patient relationship as well as expose the patient to hidden risks. These risks include improper shipping of medicines as well as unsecured supply chains. For instance, they will ship months worth of insulin which is sensitive to heat, cold, vibration, and sunlight. The shipper may not adhere to the tightest quality control in transit. Hence, when you finally get the product, it may not work as it should. Unlike pharmacies that are subject to state inspection, UPS, Fedex, etc are not.
From karen, rutherford, nj My pharmacist caught several mistakes on my scripts. I will always go to my neighborhood pharmacy, regardless of the cost.
I do agree that they should allow us to obtain a 3 month supply , rather than on at a time. Just makes more sense.
From DKivette I ABSOLUTELY HATE DEALING WITH EXPRESS SCRIPTS! No wonder it's less expensive, I am doing all the work and all of the records maintenance. When you get a new prescription YOU have to delete the old one from their website. My husband has prescriptions from three different carriers. We have been forced to use ES by one of them. He's retired on disability due to SERIOUS on the job accident 10 years ago. They send the wrong meds and also have sent two different meds for the same condition that if they both had been taken, it would have been catastrophic. An error was made and there was no phone call warning note sent with the second bottle of meds. This would never have happened with my regular pharmacy. Also, because he doesn't get meds all in one place they can't cross check for interactions. My regular pharmacy has always done so. By the Way…Don't EVER give them your credit card or debit card number!
From Carolyn Dupre', Denham Sprfings, La. We are all up in arms about the government 'socializing' our medical care, yet we stand by and let corporate medical intities "manage" what we are going to pay for their services. Isn't this kind of an oxymoron? Drug prices alone are 'bankrupting' our senior citizens,even with the Part D segment of medicare. Yet congress agreed not to 'bargain' with the pharm companies on behalf of medicare when that plan was established. Score a BIG one for the Lobbyists and their corps. Where health care and private citizenry are concerned, Corporate America has us by the – ahem – cajunas, and yet we're screaming against governmet health care plans. What's wrong with this picture?!!!!
From Ken, Milltown WI Mail order pharmacy is one of the biggest scam PBMs are involved with. They will adjust copay structure for the consumer but ultimately the party responsible for paying the bill pays through the nose. We recently looked at what local companies paid for the "services" offered by their PBM and found that mail order was costing them up to 20 times what they could have paid without the PBM. It is time the government regulates these companies or moves away from doing business with them.
From Claude, Marysville OH I'll bet that Cigna called no less than 200 times (most calls went to voice mail) about the mail order service, and I always told them that I enjoyed going to my pharmacy. Cigna was very "pushy"…they can pound sand.
From Mark Peacock, Osceola, WI This is a corrupt system. Medco was once owned by drug manufacturer Merck. Drug companies pay the PBM to have their drugs sold and now the PBM forces the consumer to buy from them via mail order. The PBM gains both ways. Who does the accounting to verify that the PBM really saves anyone money? The PBM itself. Talk about sleaze!
From George, Lynchburg, VA Does anyone realize what happens to medications sitting in a hot mailbox all day during the warm months of the year?
From Jords, Brookfield, WI I can't count the number of times my pharmacist has caught errors, based on the fact he knows me and my various allergies, medications, etc. Nothing against my postman, but for something as important as the medicine I put in my body, I prefer to deal with a trained human, thank you very much.
From Donald W Shaw Nashville, In. I Used CVS mail order for Synthroid .1 MG 3 months supply and paid $16 00. On 08/02/2008 I was charged $ 42.71 I called and they said it was a software problem . After this order all others came to $16.00 .. I called them many times and
they said the last time check in March 2009..Now they said a check would be sent.. On March 9 CVS said it would be my insurance carriers problem…CVS was contacted 12 times with different methods for returning the overcharge
but would agree that I and others should have the difference soon… I am now with Medco..Did anyone else have this problem?? Don Shaw
From Anonymous I am forced to use mail order and I hate it. Every single time I mail my maintenance meds, they lose them…….mothing but aggrevation
From Robert, Euclid, Ohio If mail order is cheaper what's all the fuss. Corner drug stores can and should start selling fresh nutritional foods. If fresh nutriional food was on the corner of my block or within walking distance I would spend more money there than I do on prescription meds.
From Chris Huntsville Ala. Mail order stinks! Too many mistakes, no one to discuss the meds with much less help us. They are always late and it's always a fight with them no matter what it's about. I've paid extra just to have my neighborhood pharmacy fill my prescriptions. Plus they do want to know how I'm doing and how my husband is doing and our mom's and our friends who go there also. Mail order could care less and really wishes we would all go away.
From UE, New Jersey Unfortunately, these days we're all busy and we're trying to save money where we can so I, like many other people, order my maintenance prescriptions by mail through my insurer at work. I can order a three month supply, have it sent directly to me, and save a little money too. I only go to the local pharmacy when I need a "one-time" prescription. I hate to see the neighborhood pharmacies struggle or fail, but mail order is just more convenient and economical overall.
From CM Jones, Elkin, NC Havent we learned our lesson yet about letting a few big companies dominate/monopolize their markets ?!!? From a small town myself, I truly appreciate the town pharmacist. He goes all out, even making housecalls to deliver medications….he CARES. THEY DONT.
From Steve Bethany Ok Mailorder has no personal touch. My pharmacist has the ability to explain and answer questions. He can also spot a conflict in meds…question me if a certain med has been discontinued so as to make no harm. A brown envelope in the mail just does not get the job done. I will take my pharmacist any day.
From Susie, Cleveland OH The only thing good about mail order is the savings. I have to go through Caremark. Why can't I just go to CVS every month to get my meds? HELLO, same company! Ding Ding Ding. They're losing money on me because every time I went to pick up my prescriptions, I usually spent $15-$20 on other things. I filled my first prescriptions last month and I wrote the check for the exact amount the representative quoted me on the phone. Then I get the receipt and it was $5 cheaper. That's $5 that would have gone into my gas tank, but instead, I now have a "credit". I HATE THIS!!! I'm capable of driving myself to the store. I don't want to have to worry about getting my stuff in time. It should be a choice, NOT mandatory.
From Sammie, Atlanta GA I tried to support the corner pharmacy, but the hours were so limited I was forced to go elsewhere.
From janet wilburn Big mail-order pharmacies are certainly part of the equation of why our medical and perscription costs are so high. I long for the day when I could call my pharmacist and visit with him regarding my medical perscriptions. He knew me personally, and helped me more often than other medical facilities.
From Michael Day, Chattanooga, TN The slow death of the independent pharmacies is really sad and has as much to do with the insurance companies as it does the PBMs. I once worked for a pharmacy where the pharmacist knew his customers' names, offered FREE delivery 6 days a week, and though he wasn't open 24 hours like a generic Walgreens, was more than willing to get up in the middle of the night, drive to his store, fill a prescription for your sick family member and deliver it personally to your house. Caremark, Medco, Express Scripts, and all the pharmacy chains will never be able to match the service a caring, self-employed pharmacist will always deliver.
From Randy, Concord, NH I can't stand the mail-order routine. I often took the opportunity to talk with my pharmacist about how I was reacting to the meds. I blame our HMO, Anthem, for insisting I use mail order or pay the $1300 / month cost myself.
From Lorna Shepard Bristol, CT My two children are on many psyche medications to handle their neurological disorders. I pay an extraordinary amount of money each month to fill their 12 scripts. While I would save money by using mail order drug service, it is impossible to use as their medications are frequently changed every month and I would be stuck with medications that I cannot use. The trend with insurance carriers is to force their members to use mail order drug and my hope is that the government will step in if the insurance companies have their way and disallow or penalize monthly retail fills.
From Kenneth Bock CNN Buisiness
Funny you should run an article on local pharmacies. We retired in a small town and after moving here found that United Health Care did not use any of the local doctors in their health care plan. We now drive two and one-half hours each way to Portland Oregon for each and every medical appointment. The UHC drug plan REQUIRES you to use MEDCO for 3 month pill supplies. So my local pharmacy across the street can only provide one month supplies because of a rule by UHC. Isn't that against the law FOR RESTRAINT OF TRADE?
Ken Bock
Astoria, Oregon
From Michele Bowes, Bradley Beach, NJ Why are we limiting this discussion to Mail Order Prescriptions? For the sake of all Americans, in order that we can get everything we need "on the cheap", and aid Corporations in meeting their needs for continued double-digit groth, let's designate one company for each industry as the "go-to" source. (And the hell with competition altoghether.)
From Perry Lewis, Big Rapids,MI To Whom It May Concern,
I've been a community pharmacist in the Mecosta County area since
1972 and over the years have seen many changes in health care; some
very good and some not so good. One that is not so good, in my
opinion, is mail order pharmacy. Not only can't the patient have a
face-to-face with their pharmacist; they must usually mail their
prescriptions to another state especially if they are taking
chronic medications and wish to get a ninety days supply on their
insurance. Michigan pharmacy rules forbids the establishment of
any mail order pharmacies within our state, but most employees of
this state have health
insurance plans which encourage mail order
pharmacy. Many years ago a customer that worked for the MESC came
into my pharmacy to have her blood pressure medication refilled
and said to me "You won't be seeing much of me anymore, because we
have prescription insurance plan and I can get 3 months of my
medication by mailing my prescriptions to Columbus, OH." I said we
would be sorry to loose her, but didn't she consider that sending
her hard earned money to Ohio might just be a bad thing for our
state especially given that she worked daily with the unemployed.
The thing was she could only get 1 month of her med at a time from
us.
Now consider this as I said above; most if not all employees of
the state either directly or indirectly have this kind of insurance.
This would include:state troopers, the highway commission, all
state
colleges and all the representatives with their staffs and the
bureaucracy in Lansing. That is a lot of folks that are potentially
sending their Michigan dollars (that will never come back) to other
states.
I've spoken to a number of these people over the years and most
tell me they would rather have their prescriptions filled locally
if they could get that ninety days supply. Our state negotiates
these insurance plans and could, like other states have, demand that
the playing field be leveled so that their insured would have a
choice. Think what that might mean to our economy, both local and
state wide,if just half of that money were spent here rather than
sent out of state. At the very least it might put more residents to
work and they in turn would support our economy with their earnings
and their taxes.I'm sure someone in
Lansing knows exactly how much
money is involved here and I'm betting it is a lot and I haven't
even mentioned the auto workers who also have similar insurance
plans.
I have no quarrel with someone who has that choice to use mail
order and certainly many would continue to do so, especially those
who have trouble getting around, but just offer that choice.
Please don't take my word for any of this but investigate for
yourself. Check how much of our tax dollars go for this. Check
with other pharmacists. Many chain pharmacies are involved with
mail order but I think their employee pharmacists would agree with
my conclusions.
I just read a small notice in the Michigan Pharmacist Journal that
the "Pinckney Pharmacy, one of only three independent pharmacies
remaining in Livingston County had to sell out primarily due a
decline
in business from increased competition from mail order."
Now isn't that a shame, a local business has to shut down and more
people out of work.
I sincerely believe changing the mail order contracts would be one
very good way to help our lagging state economy.
From Chuck, C/S CO Not all is lost for independent pharmacies. I to liked the mail order, 90 day and cheaper or was cheaper. I have United Health Medical and Medco for prescriptions it now costs more to mail order and thay even show the savings on the web site. I can get 3-30 supplies for less much less than 1-90 mail order. So why Medco is still a player there I never know.
From Dick, Rochester, NY By removing the pharmacist from the chain of communication, which is what the mail order business does, you remove an important link that helps protect the consumer. The pharmacist can help advise, answer questions, spot problems, etc., and the mail order process simply ignores this. Lower cost does not mean better for the consumer.
From Richard, Düsseldorf NRW Well, I've been working with Europa Apotheek in Venlo, Netherlands. It's the first company I ever ordered prescription drugs from by mail.
The verdict: Their prices are somewhat lower than those at the local drug stores. Their delivery is quite fast and they have yet to screw up an order. On the whole, I'm pleased with the service and plan to continue working with them.
By the way, it did not escape my notice that my prescription medications are, per unit, significantly cheaper than those I was buying at Walgreens in New England (sorry Walgreens). Not only that, but my doctor can pretty much prescribe any quantity of the medication he sees fit (The Netherlands is good that way; German officials know better than my doctor how much medication is too much for me).
Also, Walgreens invariably made me wait at least one day while the local store sent out to the warehouse for my somewhat unusual medication. (But then again, so did CVS). So the advantage of immediacy that the corner drug stores have over the mail order guys was sort of diminished.
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Starting the new year the company I work for is again changing the insurance they carry, and now forcing us to order our "Maintenance" drugs through the mail order program. not only have they raised the copay but I will almost have to pay triple the cost of a 90 day supply. And this is supposed to help us how?