When I called my pharmacy to refill my blood pressure medication prescription a live person answered. I was so startled I blurted out, “Why are you answering the phone?”
I had autodialed the familiar voicemail phone number for prescription refills at the pharmacy I had patronized for the past eight years.
My beloved pharmacy (because it had seen me through the trauma of my wife’s brain cancer treatment) had quit the retail pharmacy business and turned over its retail accounts and phone number to this other pharmacy without warning.
Irony of ironies, I had fled to my beloved pharmacy to escape this same national chain pharmacy and here I was back in it clutches.
For me, with few prescriptions, easy mobility and no insurance restrictions, finding a new pharmacy was merely a nuisance. But I empathized with all the more constrained discarded patients who would be seeking a new pharmacy. What a disaster this would have been when my wife was in cancer treatment! How difficult this was going to be for weak, elderly, confused and sick patients and harried caregivers, especially those with many prescriptions!
But even I was dreading what I foresaw. I not only foresaw the hassle of finding the price, service and convenience I desired, but I dreaded the predictable effort to expunge the old pharmacy from my medical records and get the new pharmacy to the top of my medication list. Previously it had taken nearly two years to eradicate my old pharmacy and eliminate the inevitable question of which pharmacy I wanted my new prescription or refill faxed to. It would probably be the same today as it was eight years ago: I was told then that neither my doctor nor anyone in his practice was empowered to delete my old pharmacy from my medical records. But I was assured that as my new pharmacy was frequently entered into the computer it would rise to the top as the all-wise software learned and functioned when presented with my data.
I made the following list of my prescriptions and took it to RiteAid, Fred Meyer and Costco pharmacies in Bellingham, WA. I went to each pharmacy around mid-day, to the drop-off window, and handed over my prescription list. RiteAid and Fred Meyer wrote down prices immediately. At Costco I returned after 10 minutes to pick up my price quote.
Somewhat to my surprise, my prescriptions had become cheaper after I lost my private insurance when my wife died.
Here’s how that worked. There was a lot more to it than this and there are as many variations as there are insurance plans, but the keys in my case were that the post-insurance prescription transactions were now between only the pharmacy and me, without the interference of insurers, benefit managers or other parties. More importantly, I could get 100 doses at a time instead of the maximum of 30 doses mandated by the private insurer’s cost containment management. One hundred doses of some generics cost just 10 or 15 percent more than 30 doses.
Knowing this, I elected to not get Medicare part D prescription coverage because I calculated that the added premium (and maybe co-pay) would exceed my out-of-pocket cash cost. Now, four years later, this is still the situation.
DEFUNCT PHARMACY, CASH PRICE December 2014.
Lisinopril 40mg, qty 100, $ 20.00
Atenolol 25mg, qty 100, $12.00
Temazepam 15mg, qty 50, $29.00
Pravastatin 40mg, qty 100, $15.00
Fluoxetine 40mg, qty 100, $16.99
RITE AID, CASH PRICE March 2015.
Lisinopril 40mg, qty 100, $16.99
Atenolol 25mg, qty 100, $16.99
Temazepam 15mg, qty 50, $29.74
Pravastatin 40mg, qty 100, $16.99
Fluoxetine 40mg, qty 100, $16.99
FRED MEYER, CASH PRICE, February 2015.
Lisinopril 40mg 100, $68.99~
Atenolol 25mg 100, $11.11
Temazepam 15mg 50, $39.29
Pravastatin 40mg 100, $129.49
Fluoxetine 40mg 100, $128.49*
~100 20mg Lisinopril $22.22
*100 20mg Fluoxetine $43.24, cheaper to take two.
COSTCO, CASH PRICE, February 2015.
Lisinopril 40mg 100, $11.69
Atenolol 25mg 100, $10.89
Temazepam 15mg 50, $16.83
Pravastatin 40mg 100, $52.83
Fluoxetine 40mg 100, $150.90*
*100, 20mg Fluoxetine $19.75
In the recent past, 40mg Lisinopril was cheaper at my defunct pharmacy than 20mg Lisinopril so I had been cutting tablets in half because my prescribed dose was 20mg.
When I lost private drug insurance, upon the death of my wife in February 2011, I began paying cash and elected not to have Medicare D or any other drug insurance coverage. My pharmacist remarked that my basic drugs would be cheaper than they were with insurance. I paid more out of pocket, but the list price was lower than if insurance was paying for the drug. But I was able to offset most of the greater out-of-pocket cost because I could get 100 doses — 333% more pills — because the 30-day supply restriction didn’t apply since insurance wasn’t involved.
My defunct pharmacy wasn’t the cheapest on each prescription, but neither were there wild variations in price. The total price for all prescriptions was moderate and consistent, plus there was free home delivery and topnotch service and advice.
If price were the only consideration the listed prescription could be purchased for a total of $74.83 by shopping at all three pharmacies. For convenience and price RiteAid was the clear winner at $97.70. But for just $4.20 more than RiteAid and an adjustment in my dosage, Costco became a candidate. Individual needs make such comparisons moot except as they apply to an individual patient, in this case: me.
As beloved as I have testified my defunct pharmacy was, I am unable to forgive how it handled exiting the retail pharmacy business. Fortunately, I was at a place in my personal and healthcare life where the defunct pharmacy’s action had little impact on me, but that is seldom the case for many pharmacy patients and their caregivers.
As fundamental as prescription medications are to care and treatment, the pharmacy profession needs a better protocol for exiting the retail patient prescription dispensing business. I understand how messy and complicated it could be, but dumping pharmacy patients and caregivers with automated call-forwarding demonstrates that the retail pharmacy business is as uncaring as other corporate healthcare providers. The trust pharmacies practically beg for and advertise to attract customers just isn’t there. It is shameful. Beware!