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Best drugstores

43,739 readers rate pharmacies for accuracy, knowledge, and speed

Published: April 2011

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Chalk one up for the little guy. Consumer Reports’  latest drugstore study (available to subscribers) affirms that the top-rated walk-in stores are neighborhood independents, not giant chains such as Walgreens and CVS.

Ninety-four percent of readers who shopped at independent drugstores were highly satisfied with their experiences. Included in this group are The Medicine Shoppe and Health Mart, independent-like chains that are individually owned and operated but have a common parent company. Independents made fewer errors, offered swifter service at the pharmacy counter, and were much more likely to have medications ready for pickup when promised than traditional chain, supermarket, or big-box-store pharmacies, our survey found.

People who filled their prescriptions at independent stores also praised the pharmacists’ accessibility and personal service, and encountered fewer delays and medication mix-ups than those who shopped elsewhere.

Illustration: Jason Schneider

The trends

One of our most disturbing findings is that so few people are talking to their druggists about dosing, interactions, or medical conditions. In our latest survey, just 42 percent of respondents had a conversation with their pharmacist about their prescription drugs; 26 percent discussed over-the-counter medicines.

If you’re seeking answers on the Internet instead of from a health-care professional, you’re “swimming in shark-infested waters,” warns John Santa, M.D., director of the Consumer Reports Health Ratings Center. “Brand drugmakers have so much money and are so smart that it is very difficult to find information online that they do not influence heavily,” he says. “In my mind, unless you are very careful and already well informed, you should assume that whatever you read on the Internet is coming from a drug company.”

A lack of understanding about medications can have dire consequences. An estimated 25 percent of patients don’t take their medications as prescribed, resulting in as many as 188 million visits to clinics and hospitals each year.

“Health-care consumers can and should become active partners with their health-care practitioners in preventing medication errors and misuse,” says Allen Vaida, Pharm.D., executive vice president of the Institute for Safe Medication Practices, a nonprofit organization. “Patients should talk to their pharmacists, doctors, and nurses to learn how to take their medications properly and what the side effects are.”

But asking questions only at your pharmacy might not be enough. As part of our study,Consumer Reports sent anonymous shoppers to 20 drugstores around the U.S. to ask pharmacists or their assistants about the safety of taking the prescription drug Lipitor along with red yeast rice, an over-the-counter dietary supplement. Both are supposed to lower cholesterol. Taken together, they pose a greater risk of side effects, including muscle, kidney, and liver problems. But in 12 instances, the pharmacy gave the wrong advice.

We found other shifts in the patient-pharmacy relationship and trends that might change your pharmacy experience:

Readers report problems

Almost half of readers surveyed had at least one problem during a total of about 54,000 drugstore visits. Top gripes: Medicine was out of stock (at least once in the past year for 32 percent of readers), counter service was slow (cited by 21 percent), and the order wasn’t ready when promised (15 percent). Four percent of readers got the wrong number of pills, and even fewer reported medication mixups or billing errors.

The stores most likely to be out of stock were supermarkets Albertsons, Jewel-Osco, Smith’s, Stop & Shop, and Winn-Dixie. Almost half of those lacked the medicine readers needed at least once during the year. The delays were longest at Giant Food, where 44 percent of those who faced an out-of-stock drug didn’t get their prescription for at least two days. Walmart had the biggest bottlenecks at the pharmacy counter, where half of visits resulted in a long wait. Giant Food and Meijer were almost as bad.

On-time delivery improves

Overall, drugstores have gotten better at delivering prescriptions when promised. In our 2002 survey 24 percent of readers said on-time delivery was problematic; this time 16 percent said so. That’s especially good news because speed has become more important to readers. In our current survey 49 percent said the ability to get in and out quickly with medicine in hand was an important consideration in choosing a drugstore, compared with 24 percent in our 2002 survey.

Compare prices

If you have large out-of-pocket costs, comparison shopping is a necessity. That might require phone calls because many chains (with the notable exception of Costco) have removed their online price-checker feature. But the research should prove worthwhile. Our national study of prices for four common brand-name drugs (see How to save on medicine) found average total differences of $168, or 29 percent, between the cheapest source (HealthWarehouse.com) and costliest (Publix).

More discounts and freebies offered

Stores offer free diabetes drugs and antibiotics (a 14-day supply of commonly prescribed generic versions), low-priced generic prescription drugs (a 30-day supply for $4 or three months’ worth for about $10), and discounted immunizations for flu, measles, chicken pox, tetanus, pneumonia, hepatitis, HPV, and other conditions. (Pharmacists in all 50 states are now permitted to inoculate.)

Many chains, including CVS, Publix, Shopko, Walgreens, and Walmart, have set up walk-in clinics where approved health-care providers offer services such as inexpensive physicals for school sports, pregnancy tests, and treatment for ailments such as bladder infections, poison ivy, and pinkeye. Some stores provide screenings for skin cancer and high blood pressure. Increasingly, chains are giving their best deals to those who join the store’s loyalty or preferred-shopper programs. Membership is sometimes free, and customers might receive points toward future purchases (Rite Aid and CVS), 10 percent off store-brand products (Kinney Drugs), $5 off the price of a flu shot (Winn-Dixie), or a $25 credit for transferring their prescription from another drugstore (Fred Meyer).

Be careful buying on the Internet

Though there are credible online pharmacies, such as those affiliated with physical stores (CVS.com, for example), most are shady. That’s the conclusion of the National Association of Boards of Pharmacy, which accredits online drugstores. Of the more than 7,000 online drugstores whose practices the NABP has reviewed, only about 3.5 percent appear to be legitimate. The rest sell foreign or non-FDA-approved drugs, don’t require a valid prescription, or lack a physical address, for example.

Those “rogue” pharmacies continue to defy federal efforts to banish them and have actually gotten more brazen. According to the NABP, many rogue sites have expanded their offerings from drugs for sexual performance or weight loss to painkillers and other narcotics. Site operators often hide behind legitimate-looking storefronts, some of which appear to be based in Canada, whose regulatory system is similar to that of the U.S. In reality, they might be in China, Russia, the Middle East, or elsewhere.

E-prescribing isn’t used enough

With almost 4 billion prescriptions dispensed annually, there’s ample opportunity for wrong dosing instructions, missed drug interactions, patient allergies, and errors due to illegible handwriting. If more doctors sent prescriptions electronically to drugstore computer systems, which have access to patients’ medical histories, the error rate would drop and doctors would spend less time clearing up confusion.

Rob Cronin, a spokesman for Surescripts, which operates one of the largest e-prescribing networks connecting prescribers to pharmacies, says that roughly 40 percent of doctors are transmitting electronically, up from less than 1 percent six years ago. Yet that represents only about 18 percent of all eligible prescriptions in 2010. Sixty-nine percent of readers surveyed who use walk-in pharmacies said they still drop off their prescriptions.

How to choose a drugstore

Illustration: Jason Schneider

Find a drugstore that takes your insurance. Here are your basic choices:

Independents: Tops for care

Independents had been in decline for decades, though their numbers have held steady in recent years at about 23,000 stores. But rates for prescription-drug reimbursement from insurers continue to decline, which makes it tough for shops to stay in business. Independents get 93 percent of their sales from prescriptions; chain pharmacies, just 65 percent. (The rest comes from cosmetics, food, and other merchandise.)

At the same time, independents are facing competition from pharmacy benefit managers, or PBMs, which administer prescription plans and cut deals with drugmakers and pharmacies on behalf of large employers. PBMs offer their members incentives to use their mail-order pharmacies, and independents aren’t part of those networks. A few Medicare Part D plans are dangling incentives to clients to switch to mail-order fulfillment as well.

Because independents specialize in prescriptions, they can offer greater personal attention. “They have an intense interest and stake in ensuring that customer service is of the highest standard,” says Kevin Schweers, vice president of public affairs for the National Community Pharmacists Association. More than 90 percent of readers gave independents excellent or very good scores for pharmacists’ knowledge about drugs and other products, helpfulness and courtesy, speed and accuracy, and personal service. No other type of drugstore came close. Readers who shopped at independent stores were twice as likely as chain-drugstore shoppers to characterize their druggist as easy to talk to and able to give them a one-on-one consultation.

To support patient care, most independents also sell canes, walkers, and wheelchairs. Roughly three-quarters of them offer local delivery (usually free). Most also offer compounding, or custom-mixing of medicine, and will flavor kids’ medicine to make it tastier—services that other types of drugstores are starting to offer. One drawback: Their websites can be sparse.

Supermarkets: A lot to like

Together, the nation’s 9,000 or so supermarket pharmacies came in second to independents. Eighty-four percent of readers who bought drugs there were highly satisfied.

Supermarket pharmacies are appealing because you can shop while you wait for your medicine, and many provide frequent-shopper discounts, automatic refills, low-cost generics, free antibiotics, health screenings, immunizations, and more. Publix lets customers order online for in-store pickup; Safeway will mail your prescription; HyVee customers can get nutrition advice from registered dietitians; and Raley’s shoppers can critique their pharmacy experience on the store’s website. In Texas, H-E-B offers expectant mothers free prenatal vitamins.

Chains: Criticized but convenient

Forty-one percent of Americans buy their prescription medicine at traditional chains, more than at any other type of drugstore, yet readers were more critical of them than of other drugstore types.

The industry has shrunk to two titans, Walgreens and CVS, with more than 14,000 stores between them, according to a trade publication. Rite Aid is a distant third. Small regional chains, such as employee-owned Kinney Drug, with 91 pharmacies in upstate New York and Vermont, have many of the pluses of independents. Readers gave Kinney pharmacists high marks.

The convenience of big chains is undeniable. They accept a variety of insurance plans. Many are open 24 hours a day, have a drive-through window, and give you the option of in-store pickup or mail delivery (often free). You can also fill prescriptions at any of the chain’s locations (records are in a central database), helpful if you’re out of town.

The chains are getting better at having prescriptions ready when promised. Although 25 percent of chain shoppers in our 2002 survey said that at least one prescription wasn’t ready when promised in the previous year, only 15 percent in our new survey said that was a problem.

Chain websites tend to be comprehensive and cutting-edge, communicating offers through Twitter and Facebook. You can create a medical profile to help flag interactions, get alerts when your medicine is about to run out, have prescriptions refilled automatically, and print your prescription history. Walgreens has free iPhone and Android apps for refills and will send text alerts when prescriptions are ready. You’ll find details about drugs and supplements and be able to print coupons. You can also e-mail the pharmacist and sometimes have a live chat.

Mass merchants: The pick for cash customers

Since 2002, the percentage of readers who have prescriptions filled at big-box stores has jumped from 14 percent to 22 percent. Most who shopped at stores such as Kmart, Bi-Mart, and Sam’s Club cited low prescription prices as an important reason for shopping there.

Mass merchants continue to stress low price. Sam’s Club and Costco stores open their pharmacies to nonmembers. At Costco, members without prescription coverage can sign up for a free program for drug discounts. Sam’s Club members can get extra discounts if they opt for a pricier membership.

Customers can visit a Target in-store clinic for a physical exam or for diagnosis and treatment of minor illnesses and injuries for a fee of $59 to $69. And Kmart customers who are at least 50 years old and without prescription-drug coverage can enroll in the free Gold K program for up to 10 percent off branded drugs and up to 20 percent off generics that aren’t among those already discounted through another program.

But service lags. One in four mass-merchant shoppers complained of a long wait during at least one visit, and when the store was out of a drug, 33 percent of people waited two or more days for it. Walmart was among the lowest-rated stores overall and the only one judged worse than average in speed and accuracy and personalized service.

Online: Stick with verified sites

The Internet can be a source for cheap drugs, but be careful. “We still have big concerns about rogue sites,” says Ilisa Bernstein, a deputy director in the Food and Drug Administration’s Center for Drug Evaluation and Research. Roughly 36 million Americans have bought medications online without a valid prescription. In an international crackdown last year, the FDA contacted 294 suspect sites and corresponding Internet service providers and domain-name registries, urging that the services be shuttered. Most were suspended or otherwise no longer sold drugs, though within hours, some re-emerged under different names.

Make sure an unfamiliar site is licensed by your state’s Board of Pharmacy. The NABP has a voluntary online-pharmacy-accreditation program, Verified Internet Pharmacy Practice Sites. A VIPPS seal is a good sign that a site complies with regulations and adheres to the best pharmacy practices. The NABP also has a list of sites that it does not recommend. LegitScript is another organization that verifies pharmacies doing business online as legitimate in accordance with NABP-recognized standards.

How to save on medicine

Illustration: Jason Schneider

Medicare Part D has helped lower out-of-pocket drug costs for many seniors. Still, 43 percent of readers surveyed paid $500 or more on medicine this past year, and 20 percent spent at least $1,000. We have a prescription for people who pay out of pocket: Shop around.

From 10 online and walk-in pharmacies, we found the price we’d pay in cash for a 30-day supply of four brand-name drugs. (For each walk-in retailer, we contacted 10 shops across the country.)

The bills varied by up to 29 percent. Over a year’s time, that’s more than $2,000. On average, Web-based pharmacies were the least expensive. Costco.com’s prices were similar whether you buy online or at a store. And you usually don’t have to be a member ($50 a year) to use their walk-in pharmacies. Club members without prescription-drug coverage can reap extra savings on some drugs.

Prices for the same drug within the same chain sometimes differed by $30 or more. One Publix grocery, for example, would have charged $197 for a supply of Nexium; another, $234. Walmart’s prices were the least variable, independents’ prices the most. But on average, independents charged less than any walk-in store except Walmart.

Other ways to save

Consider generics

More than 20 of the chains in the Ratings, including major retailers such as CVS, Walgreens, Kroger, Kmart, Walmart, and Target, sell hundreds of generics for as little as $4 for a 30-day supply, or $10 for 90 days. The average price of cholesterol-lowering Lipitor in our study is $119, and in many cases generic lovastatin is a suitable substitute costing $4.

For a list of safe and effective generic drugs that work as well as or better than brand-name alternatives, go to Consumer Reports Best Buy Drugs.

Apply for a discount card

Many pharmacies have programs that let consumers buy $4 generics or qualify for steeper discounts on other drugs and services. The programs are often free. Kmart has a discount program for customers 50 and older without prescription drug coverage.

Ask for a break

Posing as an uninsured cash customer, our reporter phoned drugstores for price quotes, but in fewer than 10 of 50 calls did the drugstores suggest how he might cut his bills. About all anyone ever said was, “You’re on the real expensive ones,” or, “Your doctor’s not doing you any favors.” When he asked specifically whether the store would match a competitor’s price or give him a price break, several druggists said they’d be willing to work with him.

Talk to human resources

Especially if you take a drug for a chronic condition, ask your benefits administrator whether your company uses a pharmacy benefit manager, a firm that helps companies cut the cost of prescription-drug coverage. PBMs have formularies (lists of preferred drugs), that they make available to members, usually via mail order, at reduced rates.

The price gap for brand-name drugs

Drugstore Price  Total
  Lipitor
(reduces cholesterol)
Nexium
(reduces acid reflux)
Plavix
(prevents blood clots)
Singulair
(prevents asthma attacks)
 
healthwarehouse.com $98 $172 $171 $129 $570
familymeds.com 109 185 165 133 592
costco.com 110 187 181 139 617
drugstore.com  110 201 170 144 625
Walmart 112 200 177 137 626
Independents:
Health Mart,
The Medicine Shoppe
125 201 195 141 662
Walgreens 130 214 195 153 692
Safeway 126 215 212 156 709
CVS 131 230 203 164 728
Publix 135 228 214 161 738

 For walk-in stores, prices are averages.  Standard shipping of prescription medicine is free at all of the Web pharmacies except Drugstore.com, which charges $2.99 per order.

How much does your druggist know?

An undercover investigation byConsumer Reports suggests that some pharmacists are uninformed about potentially harmful interactions between over-the-counter supplements and prescription drugs.

We sent shoppers to 20 pharmacies in five states to ask the pharmacist or an assistant whether it was permissible to take atorvastatin (Lipitor), a widely used cholesterol-lowering drug, along with red yeast rice, a dietary supplement that is touted as a natural way to reduce cholesterol. Red yeast rice is a rice extract fermented with a strain of red yeast, and laboratory evidence has shown that it contains a substance essentially identical to the cholesterol-lowering drug lovastatin. Consumer Reports has recommended against using it. Moreover, taken together, the two might raise the risk of side effects such as muscle aches and pains and a rare muscle disease that could result in kidney failure. Over time, it might cause liver damage as well.

Twelve of 20 times, shoppers got incorrect or fuzzy advice, sometimes even after the druggist consulted an online medical database. In two cases, a pharmacist said taking both medications was a good idea. One of those pharmacists, in Albany, N.Y., revealed that he and his wife used red yeast rice and said he recommended it to all his customers who take a cholesterol-lowering product. A pharmacist-technician at a Safeway in Richland, Wash., was clearly bothered by our shopper’s questions and directed her to a health-food store for advice. Other pharmacists seemed unfamiliar with the supplement, shrugged, or gave wishy-washy answers.

The responses suggest that many pharmacists might not know enough about supplements, which aren’t subject to the kind of federal regulations that drugs are.

Orly Avitzur, M.D., a board-certified neurologist and Consumer Reports medical adviser, said she wasn’t surprised by the results of our investigation or convinced that physicians know more than pharmacists about dietary supplements. “When more physicians have electronic medical records with fully functioning medication modules, drug and supplement interactions will be flagged automatically, and we hope these problems can be avoided,” she said.

How to avoid medicine missteps

Bad advice is just one reason behind medicine mistakes. You might miss a dose or take it with food or drink instead of on an empty stomach. Other reasons include confusion between similar-sounding medications, poor handwriting on prescriptions, and incomplete information about your allergies. To make sure you get the right medicine in the right dose:

Give the pharmacy your complete history

Include a list of drugs, vitamins, and other dietary supplements you’re taking and information about medical conditions, allergies, and adverse reactions. Some drugstores let you create a secure profile online that you can update with new information.

Understand how to take medicine

Does it matter whether it’s in the morning or at bedtime; or before, during, or after a meal? Can you crush or chew it? Should you avoid any foods, beverages, other drugs or supplements, or activities while on the medicine?

Ask what happens if you miss a dose or take too much. If too much time passes, do you double up or wait? If you suspect an overdose, should you go to the hospital?

Know the side effects

Do any problems warrant immediate attention?

Ask whether you can stop once you feel better

With some drugs, notably antibiotics, if you cut the regimen short, the bacteria might survive and cause the infection to recur.

Know the time frame

Does “three times a day” mean during waking hours or during a 24-hour period?

Store medications properly

In general, select a cool, dry place away from direct sunlight. A bathroom medicine cabinet isn’t ideal because of moisture and heat, which can cause some drugs to break down. If you store pills above a sink, they could fall down the drain. Keep refrigerated medications out of the door because of temperature variations.

Remove roadblocks

Sometimes, difficulty opening the bottle, illegible instructions, and bad taste are reasons people don’t take their drugs. Ask for an easy-open bottle, large-print labels, or special flavoring.

Best pharmacy benefit managers

Pharmacy benefit managers are companies that handle the prescription-drug part of the health-care benefits provided by insurance companies, self-insured companies, managed-care groups, and government programs. They’re an adjunct to a health plan, not a substitute, and you don’t pick a PBM; your employer does. PBMs, which have websites and phone service but no stores, cut a different deal with each client.

They earn their keep by controlling the administrative costs of processing drug claims and ensuring that appropriate drugs are prescribed. PBMs buy drugs in such quantity that they can make deals with drugmakers and pharmacies on behalf of their clients, who might pass savings to employees. The savings are usually only for drugs in each PBM’s list of approved drugs.

As part of our drugstore survey, more than 18,000 readers told us about their experiences with 10 of the nation’s largest PBMs. Tricare, which provides outpatient prescription drugs to more than 9.6 million active and former members of the U.S. military and their families, was a clear winner, but other PBMs left readers highly satisfied, too.

Most PBMs have online tools to calculate what you’ll pay for a particular drug and how you might save. They might compare the price of a 30-day supply of a drug filled at a local pharmacy with the price of a 90-day supply ordered through them and mailed. It’s worth noting that more than 20 percent of WellPoint customers complained about its website.

Insurers, PBMs, and your employer have a stake in saving money, so they could potentially steer you to a store or drug that might not be best or cheapest for you. But that risk has declined sharply in the past decade.

Guide to the Ratings

PBM Ratings are based on the experiences of 18,573 Consumer Reports readers between April 2009 and April 2010. Reader score is calculated on the same 100-point scale as in the Ratings.

Best drugstores Ratings

Guide to the Ratings

The Ratings are based on 43,739 responses to a survey by the Consumer Reports National Research Center, reflecting 53,795 reader experiences buying prescription drugs at walk-in chain, independent, supermarket, and mass-merchandise stores between April 2009 and April 2010. The results represent our subscribers’ experiences, not necessarily those of the general population. Pharmacies consistently satisfy readers better than most stores or services (better than supermarkets and cell-phone service; about as well as electronics stores). As a group, 80 percent of respondents were completely or very satisfied with their experiences buying prescription medication. Reader score indicates overall satisfaction. A score of 100 would mean all readers were completely satisfied; 80 means they were very satisfied, on average; 60, fairly well satisfied. Differences of less than 5 points are not meaningful. Survey results reflect how each pharmacy did compared with the others. They encompass important aspects of the shopping experience: Speed and accuracy, the factor most closely tied to satisfaction, reflects how long readers had to wait for service at the pharmacy counter and whether their medications were ready when promised. Other aspects include helpfulness and courtesy; pharmacists’ knowledge (readers’ judgment of professionalism and competence); and personal service (readers’ perception of how well the pharmacist understood their medical history and tailored care to their needs).

   

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