Pharmacies

Pharmacy Buying Guide
Pharmacy Buying Guide
Getting Started

"Corner drugstore" is an apt phrase: you can hardly turn a corner without running into a CVS, Rite Aid, or Walgreens. The U.S. is home to more than 7,400 CVS stores alone. But if you're still going to a pharmacy chain for prescriptions, as do half of our readers, you might be missing out. As a group, pharmacy chains scored no higher in our Ratings of walk-in drugstores than big-box chains such as Costco and Walmart, and both types of store were bested by supermarkets and independent pharmacies. Independents (and the independently owned franchise chain Health Mart), as well as the regional supermarket Wegmans, earned readers' top marks for speed and accuracy, courtesy and helpfulness, and pharmacists' knowledge. (Read about the price differences between generic drugs and brand-name drugs.)

1

What to Consider

Can you easily consult with your pharmacist? Establishing a good relationship with a pharmacist you trust is the No. 1 reason to choose a drugstore, says Lucinda Maine, CEO and executive vice president of the American Association of Colleges of Pharmacy. "You can and should expect your pharmacist to be both accessible and knowledgeable," she says. "If he or she is not, then you should take your business elsewhere."

Do you have to wait for prescriptions? You're much less likely to wait at an independent pharmacy than at another type of store, according to our survey. Only 7 percent of customers at independents reported that a prescription wasn't ready when promised during the previous 12 months; just 4 percent complained of long waits. By contrast, 19 percent of shoppers at pharmacy chains found that a prescription wasn't ready, and 21 percent experienced long waits at the service counter.

Keeping customers waiting is actually part of the marketing strategy at some stores, says Murph Najjar, who spent more than 12 years as a pharmacist at drugstore and grocery chains before establishing the independent Liberty Pharmacy in Austin, Texas. "They'd like you to use that wait time to shop," he says. "It's also why the pharmacy is typically located in the far back corner. By making you walk past as many products as possible, they hope to entice you to buy something."

Are your medications in-stock? Overall, almost 40 percent of shoppers reported that a drug they needed was out of stock in the past year. At Albertson's, the worst offender, 54 percent had that complaint, as did at least 45 percent of shoppers at Jewel-Osco, Kmart, Medicine Shoppe, Rite Aid, Safeway, and Sam's Club. Only about 25 percent of customers at Health Mart and 15 percent at Kaiser Permanente complained that a drug was out of stock. As a group, independents were more likely than other types of pharmacies to restock a drug later that same day or the next.

Do you need delivery? Independents are still your best bet for anytime delivery. Ordering by mail is another option, and 36 percent of all survey respondents bought prescription drugs from a mail-order pharmacy during the previous 12 months. Nine of 10 did so from an employer- or insurance-managed pharmacy benefit management program such as Express Scripts or Caremark. Relatively few bought from online-only pharmacies such as Drugstore.com or the websites of walk-in pharmacies.

How much will you pay? If you don't have insurance or have high out-of-pocket costs, calling around to comparison shop is a necessity. The out-of-pocket price (what those without insurance are charged) can be ten times higher at some retail pharmacies than at others­—even in the same zip code. That's what we discovered in a national price scan that involved having secret shoppers call more than 200 pharmacies in six areas around the U.S. to check prices on five common generic drugs. In general, we found lower out-of-pocket prices at warehouse stores such as Costco and Sam's Club as well as some independents than at big pharmacy chains such as CVS and Rite Aid. Of course, if you have health insurance and have met your deductible, the co-pay is usually the same regardless of the pharmacy. But double-check your plan. Some companies have negotiated discounts with "preferred" pharmacies or mail-order plans.

Does your pharmacy offer discounts? Many stores offer great deals on commonly prescribed generics for people who pay for the prescription outright rather than using insurance: $4 for a 30-day supply or $10 for three-month's worth. But check the fine print. There may be a small fee to sign up and not all discount programs are open to people on Medicare, Medicaid, and Tricare. And aside from those $4/$10 deals, we found the discounted prices at retain pharmacy chains was often still higher than the out-of-pocket price you pay at Costco.

Does your pharmacy offer preventive care? Many people don't realize the array of other immunizations available at drugstores. (Pharmacists in all 50 states are now permitted to inoculate.) As with medications, people lacking insurance coverage should shop around for discounts. If you have health insurance, the pharmacy will file for vaccinations with your carrier just like the doctor's office does. Plans cover many vaccines with no co-pay, so you might not be charged. Rules vary by state, but drugstores might offer vaccinations for chicken pox, hepatitis A and B, the human papillomavirus (HPV), measles, pertussis (whooping cough), pneumonia, polio, shingles, and tetanus. Stores that provide travel immunizations, including Target and Walgreens, also cover vaccines for meningitis, typhoid, and other diseases. Some pharmacies offer health and wellness programs. For example, Walgreens will perform a weight analysis based on waist circumference, body mass index, and body composition (percentage of body fat and skeletal muscle). Kroger pharmacies and others offer smoking-cessation programs. If you try one, be sure that the pharmacist is certified and trained to provide such counseling, and let your doctor know that you've entered the program.

Does your pharmacy use up-to-date technology? If you'd rather use your computer, tablet, or smart phone, look for a chain that has integrated those technologies into the pharmacy experience. Although independent stores are less likely than other types to have an interactive website, most chains will let you handle the majority of your business online. You can check the number of refills remaining, place orders, and designate a time for pickup. You can also sign up to have the pharmacy refill your prescriptions automatically and notify you when they're ready. And, of course, there's an app for that. For example, CVS and Walgreens have mobile apps that let you order refills by scanning the pill bottle with your smart phone. Other nice features: The CVS app will allow you to identify a drug based on its color, shape, and imprint, and check drug interactions on OTC products; the Walgreens app lets you chat with a pharmacy expert 24 hours a day.

Do you need personalized services? Do you ever forget to take medications? Walmart, Sam's Club, and some independent drugstores will put your pills in blister packs, so you can tell at a glance that a dose has been taken. Jaeger suggests asking the pharmacist to package pills according to when they need to be taken. "We can group them," she notes, "so instead of a bunch of pill bottles, you'll have individual packages, neatly labeled with the contents and time of day to take them—breakfast meds and bedtime meds, for example." Most independents offer compounding, or custom-mixing, services to tailor medication for individual patients. They can make a medication without a certain dye for a patient with an allergy, for example, or create a liquid version of a drug for a patient who has trouble swallowing pills. Independents also usually stock specialized medical items such as walkers, canes, oxygen, and ostomy supplies.

2

Sorting out the Stores

Depending on what kind of pharmacy shopper you are, one choice may be better than another. Of course, it is best to first find a drug store that takes your insurance. Here are your basic options.

If you value personal service: Independent drugstore

Independents scored highest in every area of customer service. At least 90 percent of shoppers at independents rated their pharmacy as Excellent or Very Good in speed & accuracy, courtesy & helpfulness, and pharmacists' knowledge. No other type of drug store came close. Readers who shopped at independent stores were twice as likely as chain-drug-store shoppers to characterize their druggist as easy to talk to and able to give them a one-on-one consultation.

Although pricing varied among independents, our secret shoppers found some of the best deals at mom-and-pop stores.

If you want one-stop shopping: Supermarket chain

People who switched to a supermarket pharmacy, from either a different type of drugstore or another supermarket, were most likely to list convenience as a reason. 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, HyVee customers can get nutrition advice from registered dieticians, and Raley's shoppers can critique their pharmacy experience on the store's website.

But if you pay out of pocket for your prescriptions, be sure to comparison shop; we found wide fluctuations in pricing among supermarket pharmacies.

If you like rewards programs: Pharmacy chain

Shoppers at pharmacy chains were far more likely to use store loyalty cards than were those who shopped elsewhere, and 87 percent of those who did so reported saving money. But you should know, even though more Americans buy their prescription medicine at traditional chains than at any other type of drug store, readers were more critical of them than of other drug-store types. They also charge high out-of-pocket prices we found. The industry has shrunk to two titans, Walgreens and CVS, with more than 15,000 stores between them. Rite Aid is a distant third. 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), which is helpful if you're out of town. 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.

If you're looking for the cheapest price: Big-box chain

Almost half of our readers who switched to a big-box pharmacy said they did so for better prices on prescription drugs. Our survey found that, on average, big-box customers spent the least out-of-pocket on medications. Our national price scan revealed that two warehouse stores--Costco and Sam's Club--quoted low out-of-pocket prices. You don't need to be a member of either chain to use their pharmacies, though membership can get you even deeper discounts. For example, Sam's Club fills some prescriptions free for members.

If you're a homebody: Mail order, maybe

Mail order can make sense if you want your drugs to come to you. But be aware that there have been some complaints about service. If possible, choose a mail-order company that confirms orders before shipping. Although ordering by mail can be convenient, it's less personal and can lead to errors in communication. Even after you've discontinued a drug, for example, a mail-order company might keep sending and charging for refills until you tell it to stop. As of Jan. 1, 2014, the Centers for Medicare & Medicaid Services required mail-order pharmacies to obtain consent from a patient or caregiver before shipping a new prescription or refill.

Online pharmacies may also offer low prices, but the internet is full of fraudulent pharmacies, so you have to be careful where you shop. See our tips in "How to save on medicines" for how to identify legitimate sites.

3

Tips for Switching Pharmacies

Changing pharmacies isn't difficult, but you need to follow all of the steps to make sure that everyone involved in your family's health care has up-to-date information. Here's what to do.

• Let the new druggist handle transfers. Much of the work to transfer prescriptions, including remaining refills, is done electronically these days. Depending on your state laws, refills for controlled substances might not transfer, in which case you'll need to have your doctor issue a new prescription.

• Do the paperwork. Your pharmacy needs a complete profile of every family member, including insurance information, medical history, and a list of every drug used--prescription and over-the-counter drugs, herbs, supplements, topical preparations, and even eye drops.

• Notify your doctors. It will save time and confusion later if you call your doctors' offices and update the pharmacy information in your file.

• Fill all prescriptions at the new store. Chain stores frequently entice customers with discounts and gift cards for transferring or bringing in a new prescription. But once you've found a drugstore that suits your needs, it's safest to fill all of your prescriptions there if you can. "Jumping around might save you a few dollars here or there, but it's bad in the long run because no one place will have a complete medical profile," Hoey says. "We can't alert you to potentially dangerous interactions if we don't know everything you are taking."

4

How to Save on Medicine

Millions of Americans are being hit with skyrocketing drug costs. People who's insurance company stops or reduces coverage of a drug—or those without coverage at all­—are most likely to feel the pinch. But even those with insurance are facing higher deductive and co-pays. In fact, a recent Consumer Reports National Research Center poll of 1,037 adults showed that a third of those who currently take a drug said that they experienced a price hike in the past 12 months—anywhere from just a few dollars to more than $100 per prescription. If you're facing high drug costs, one of the first things you can do is talk to your doctor who may be able to prescribe lower-cost alternatives in the same class of drugs. For example, regardless of which pharmacy you use, switching from a brand-name to a generic can save you money as much as 90 percent in some cases. Savvy shoppers can also save in several other ways:

Skip Chain Drugstores
In our national pricing survey, big pharmacy chains such as CVS and Rite Aid consistently quoted the highest prices for people paying out of pocket. Among all of the walk-in stores, Costco charged the least.

Don't Always Use Your Insurance
In some cases, the price you'd pay without insurance is actually less than your co-pay. For example, the diabetes medication metformin sells for just $4 for a 30-day supply, or $10 for a 90-day supply, at stores such as Target and Walmart, while a co-pay for a month's worth averages around $11. Keep in mind that when you bypass you insurance, money spent on your medication won't count toward your deductible or co-pays.

Fill 90-Day Prescriptions
For drugs you take long term, it can be more convenient and even cheaper. If you use insurance, for example, your single co-pay for a 90-day supply may be less than the combined cost of three monthly co-pays.

Support Independents
We found some real bargains at independent pharmacies, where pharmacists may have more flexibility to match or beat competitors prices.

Always Ask "Is This Your Lowest Price?"
Since many pharmacies automatically process prescriptions through insurance, you won't get any available cash discounts unless you ask about them. In general, our secret shoppers found that asking can prompt the person on the phone to dig a bit for discount programs, cards, or coupons. Check back often because prices and offers may change.

Go Online
If you're paying out of pocket, check GoodRx.com to learn its "fair price" and use that to negotiate if a pharmacist quotes you a higher price. You can also fill a prescription with an online pharmacy. The one we shopped, HealthWarehouse.com, had the lowest prices overall. Only use an online retailer that clearly operates within the U.S. and displays the Verified Internet Pharmacy Practice Sites (VIPPS) seal, indicating completion of a voluntary accreditation program through the National Association of Boards of Pharmacy. Once you've verified that a retailer is legit, read terms carefully. For example, HealthWarehouse.com ships to all 50 states; others may not. And you'll have to wait for shipping. Read more about how to save money on drugs.