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.
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.