June 2008
Drugstore comparison: Which store is best for you?
Nowadays, of course, "drugstore" is a misnomer. Many sell products as diverse as soup and dog food (along with prescription
drugs for Fido) and provide immunizations, in-store health clinics, nutrition counseling, and screenings for conditions such
as skin cancer and hypertension. Our drugstore comparison found that most people still choose a pharmacy based on whether
it takes their insurance plan, but that still leaves a wide range of walk-in stores and Web sites. Here are the choices and
how they compare:
Independents: Personal service. In each of our drugstore surveys, begun in 1998, readers have ranked independents above the other types of store, probably because of their focus on prescription drugs, which account for 92 percent of everything they sell. Readers gave pharmacists at independent stores high marks for being accessible, approachable, easy to talk to (when sought out), and knowledgeable about prescription as well as nonprescription products. Independents also stock medical supplies (wheelchairs, walkers, canes, and braces) that might be missing from other types of stores and will customize medicines for patients with special needs.
Waits were uncommon, and and our drugstore comparison found that many independents offer home delivery.
On independents' Web sites, you can usually order refills, shop for medical equipment, track purchases, and do a little research.
A decade ago, independent pharmacies were an endangered species, but they rebounded after many states adopted "any willing provider" laws, which require insurance companies to take into their networks any pharmacy willing to accept the insurer's reimbursement rate. Unfortunately for consumers, independent pharmacies are again being threatened, this time by the federal government, which administers Medicaid and Medicare, including the Part D prescription-drug program for seniors. Independents rely on government reimbursement for almost 40 percent of all payments, and the government is a notoriously slow payer, says Lisa Camooso Miller, a spokeswoman for the National Community Pharmacists Association, a trade group. "Our members have been struggling," Miller says. The future of independents will depend largely on their interaction with government officials to ensure a more prompt payment system so the druggists, in turn, can pay their bills.
Chains: You might have to wait. Americans still buy most of their medications from conventional chains such as CVS and Walgreens. Chains tend to accept lots of insurance plans, many stores never close, and you can use the phone or computer to order refills you pick up at the branch of your choice, depending on the chain, or have mailed to your home. (Shipping charges are low or non existent.) The bigger chains seem to sit on almost every corner, and they've morphed into grocery stores.
At their Web sites, you can typically create a secure profile, track prescribing history, print records, e-mail questions to the pharmacist, bone up on health information, research drugs, and sign up to have prescriptions refilled automatically. Chains also are more likely than other types of stores to let you check prices online. Each chain in our drugstore comparison has a central database, so your records are on file at any store.
Taking a page from the independents' playbook, some chains are putting on a friendlier face. Snyders, a highly rated Midwest outlet, touts its "cheerful employees willing and eager to help exceed patient expectations."
However, more than one in four readers complained of a wait at chain stores. Only Medicine Shoppe (not a conventional chain) and Snyders earned high marks for pickup speed.
Supermarkets: Shop while you wait. About 10,000 supermarkets include a pharmacy, and some are open 24 hours a day. Druggists in supermarkets fill fewer prescriptions per day on average than in other types of stores, so in theory, there can be a closer relationship with patients. Four highly rated supermarket pharmacies, Publix, Hy-Vee, Hannaford, and Wegmans, were on par with the independents for satisfaction.
Supermarket-pharmacy Web sites are usually not as comprehensive as chain-drugstore sites (you often can't check prices), but you can typically renew, fill, or transfer an existing prescription; research drugs and interactions; and read articles about healthful living and preventing illness. At Safeway, you can have your prescription filled online and delivered with your grocery order.
Mass merchants: Seek special deals. Of readers who patronized big-box stores, 8 percent lacked prescription-drug coverage, which reflects the stores' focus on price. For example, Wal-Mart and Target sell a 30-day supply of more than 300 drugs, primarily generics, for $4 each. At Kmart, if you're 50 or older, you can apply for a free GoldK card, which the company says offers savings of up to 10 percent on every brand-name prescription or as much as 20 percent on generics. In our price study, Costco was the least-expensive seller of all, and you needn't pay its $50 annual fee to fill prescriptions there. If you do join and enroll in the Costco Member Prescription Program (a free benefit for uninsured members), you can save more.
Wal-Mart scored significantly lower than the other mass merchants.
Mass-merchant Web sites tend to be similar to supermarket-pharmacy sites.
Online/mail order: Save on refills. Some Web sites have no store counterpart; others do. When walk-in stores in our drugstore comparison had Web affiliates, overall satisfaction scores for the two venues were similar.
To order online, you typically enter the drug name and quantity, and a pharmacist confirms the prescription with your doctor. There's phone and online support, and you can e-mail a pharmacist.
You can usually pick up an online order at a store of your choice within a couple of hours, though you might have to pay the store price, which can be higher than the Web price. Otherwise, you can choose standard shipping for little or no extra charge (allow 5 to 10 days). Refrigerated medicine must be sent express, which can be costly. There are special requirements for the shipment of medications that contain narcotics.
Online drugstores will usually let you order a 90-day supply of medications to treat chronic conditions such as high blood pressure. In the past, many walk-in stores limited customers to 30 days' worth. But that's changing, and you might be able to order a larger supply from your neighborhood store.
In our drugstore comparison's price study, the Web sites AARP.com, Walgreens.com, and CVS.com were among the cheapest sources of medicine.
If you're unfamiliar with a site, be sure it's licensed in your state. Check by going to your state's Board of Pharmacy Web site. Some sites that are licensed and in good standing with state regulators participate in the National Association of Boards of Pharmacy's Verified Internet Pharmacy Practice Sites program and display a VIPPS seal. The program is voluntary. If you click on the seal, it should link you directly to the NABP site (www.nabp.net), offering assurance that the seal is real.
At press time, Carmen Catizone, the NABP's executive director, said the association's Web site planned to begin listing "rogue" sites, whose U.S. addresses and licensing status cannot be verified, in April 2008. A lot of unlicensed sites, Catizone says, pretend to be based in Canada but are operating out of Asia or the Middle East, and the quality of the drugs they're peddling isn't guaranteed.
PBMs: A newer way to save. Roughly one-quarter of the 57,000 medicine-buying experiences readers told us about were with PBMs, or pharmacy benefit managers, including Aetna Prescription, Anthem Rx, CaremarkRx (now called CVS Caremark), Express Scripts, and Medco. Those companies, which have Web sites and phone service but not actual stores, administer prescription plans and cut deals with drugmakers and pharmacies on behalf of large employers, giving them the clout to offer members lower prices. You don't choose a PBM; your employer does. And plans offered by each PBM differ from one employer to another.
PBMs work with their clients to build formularies, or lists of approved medicines, that encourage users to opt for cheaper drugs when possible. If payment problems arise—when, for instance, a patient is allergic to an approved drug and must use a pricier alternative—an appeal is allowed. PBMs give members e-mail or phone access to a pharmacist.
PBM members can generally buy medications at any affiliated walk-in store (just show the PBM's card or order online for home delivery). Like other drugstores, PBMs let members order a three-month supply of medicine for chronic conditions, often for the price of one or two co-pays instead of three.
Readers were generally quite satisfied with PBMs, which tended to pick up a larger portion of drug costs than regular pharmacies. But 14 percent of Anthem Rx and Aetna Prescription users had a problem with Web-site access or navigation in the past year.
Independents: Personal service. In each of our drugstore surveys, begun in 1998, readers have ranked independents above the other types of store, probably because of their focus on prescription drugs, which account for 92 percent of everything they sell. Readers gave pharmacists at independent stores high marks for being accessible, approachable, easy to talk to (when sought out), and knowledgeable about prescription as well as nonprescription products. Independents also stock medical supplies (wheelchairs, walkers, canes, and braces) that might be missing from other types of stores and will customize medicines for patients with special needs.
Waits were uncommon, and and our drugstore comparison found that many independents offer home delivery.
On independents' Web sites, you can usually order refills, shop for medical equipment, track purchases, and do a little research.
A decade ago, independent pharmacies were an endangered species, but they rebounded after many states adopted "any willing provider" laws, which require insurance companies to take into their networks any pharmacy willing to accept the insurer's reimbursement rate. Unfortunately for consumers, independent pharmacies are again being threatened, this time by the federal government, which administers Medicaid and Medicare, including the Part D prescription-drug program for seniors. Independents rely on government reimbursement for almost 40 percent of all payments, and the government is a notoriously slow payer, says Lisa Camooso Miller, a spokeswoman for the National Community Pharmacists Association, a trade group. "Our members have been struggling," Miller says. The future of independents will depend largely on their interaction with government officials to ensure a more prompt payment system so the druggists, in turn, can pay their bills.
Chains: You might have to wait. Americans still buy most of their medications from conventional chains such as CVS and Walgreens. Chains tend to accept lots of insurance plans, many stores never close, and you can use the phone or computer to order refills you pick up at the branch of your choice, depending on the chain, or have mailed to your home. (Shipping charges are low or non existent.) The bigger chains seem to sit on almost every corner, and they've morphed into grocery stores.
At their Web sites, you can typically create a secure profile, track prescribing history, print records, e-mail questions to the pharmacist, bone up on health information, research drugs, and sign up to have prescriptions refilled automatically. Chains also are more likely than other types of stores to let you check prices online. Each chain in our drugstore comparison has a central database, so your records are on file at any store.
Taking a page from the independents' playbook, some chains are putting on a friendlier face. Snyders, a highly rated Midwest outlet, touts its "cheerful employees willing and eager to help exceed patient expectations."
However, more than one in four readers complained of a wait at chain stores. Only Medicine Shoppe (not a conventional chain) and Snyders earned high marks for pickup speed.
Supermarkets: Shop while you wait. About 10,000 supermarkets include a pharmacy, and some are open 24 hours a day. Druggists in supermarkets fill fewer prescriptions per day on average than in other types of stores, so in theory, there can be a closer relationship with patients. Four highly rated supermarket pharmacies, Publix, Hy-Vee, Hannaford, and Wegmans, were on par with the independents for satisfaction.
Supermarket-pharmacy Web sites are usually not as comprehensive as chain-drugstore sites (you often can't check prices), but you can typically renew, fill, or transfer an existing prescription; research drugs and interactions; and read articles about healthful living and preventing illness. At Safeway, you can have your prescription filled online and delivered with your grocery order.
Mass merchants: Seek special deals. Of readers who patronized big-box stores, 8 percent lacked prescription-drug coverage, which reflects the stores' focus on price. For example, Wal-Mart and Target sell a 30-day supply of more than 300 drugs, primarily generics, for $4 each. At Kmart, if you're 50 or older, you can apply for a free GoldK card, which the company says offers savings of up to 10 percent on every brand-name prescription or as much as 20 percent on generics. In our price study, Costco was the least-expensive seller of all, and you needn't pay its $50 annual fee to fill prescriptions there. If you do join and enroll in the Costco Member Prescription Program (a free benefit for uninsured members), you can save more.
Wal-Mart scored significantly lower than the other mass merchants.
Mass-merchant Web sites tend to be similar to supermarket-pharmacy sites.
Online/mail order: Save on refills. Some Web sites have no store counterpart; others do. When walk-in stores in our drugstore comparison had Web affiliates, overall satisfaction scores for the two venues were similar.
To order online, you typically enter the drug name and quantity, and a pharmacist confirms the prescription with your doctor. There's phone and online support, and you can e-mail a pharmacist.
You can usually pick up an online order at a store of your choice within a couple of hours, though you might have to pay the store price, which can be higher than the Web price. Otherwise, you can choose standard shipping for little or no extra charge (allow 5 to 10 days). Refrigerated medicine must be sent express, which can be costly. There are special requirements for the shipment of medications that contain narcotics.
Online drugstores will usually let you order a 90-day supply of medications to treat chronic conditions such as high blood pressure. In the past, many walk-in stores limited customers to 30 days' worth. But that's changing, and you might be able to order a larger supply from your neighborhood store.
In our drugstore comparison's price study, the Web sites AARP.com, Walgreens.com, and CVS.com were among the cheapest sources of medicine.
If you're unfamiliar with a site, be sure it's licensed in your state. Check by going to your state's Board of Pharmacy Web site. Some sites that are licensed and in good standing with state regulators participate in the National Association of Boards of Pharmacy's Verified Internet Pharmacy Practice Sites program and display a VIPPS seal. The program is voluntary. If you click on the seal, it should link you directly to the NABP site (www.nabp.net), offering assurance that the seal is real.
At press time, Carmen Catizone, the NABP's executive director, said the association's Web site planned to begin listing "rogue" sites, whose U.S. addresses and licensing status cannot be verified, in April 2008. A lot of unlicensed sites, Catizone says, pretend to be based in Canada but are operating out of Asia or the Middle East, and the quality of the drugs they're peddling isn't guaranteed.
PBMs: A newer way to save. Roughly one-quarter of the 57,000 medicine-buying experiences readers told us about were with PBMs, or pharmacy benefit managers, including Aetna Prescription, Anthem Rx, CaremarkRx (now called CVS Caremark), Express Scripts, and Medco. Those companies, which have Web sites and phone service but not actual stores, administer prescription plans and cut deals with drugmakers and pharmacies on behalf of large employers, giving them the clout to offer members lower prices. You don't choose a PBM; your employer does. And plans offered by each PBM differ from one employer to another.
PBMs work with their clients to build formularies, or lists of approved medicines, that encourage users to opt for cheaper drugs when possible. If payment problems arise—when, for instance, a patient is allergic to an approved drug and must use a pricier alternative—an appeal is allowed. PBMs give members e-mail or phone access to a pharmacist.
PBM members can generally buy medications at any affiliated walk-in store (just show the PBM's card or order online for home delivery). Like other drugstores, PBMs let members order a three-month supply of medicine for chronic conditions, often for the price of one or two co-pays instead of three.
Readers were generally quite satisfied with PBMs, which tended to pick up a larger portion of drug costs than regular pharmacies. But 14 percent of Anthem Rx and Aetna Prescription users had a problem with Web-site access or navigation in the past year.
