YONKERS, NY — For consumers who pay for all or most of their prescription drugs out of pocket, a new price study by Consumer Reports finds that it pays to shop around.  Not only do prices vary from store to store for the same drug, but the fluctuations can be dramatic—sometimes more than $100 for the same prescription—even with the same chain, depending on whether consumers are filling their prescriptions in, say,  Omaha, Nebraska, or Billings, Montana.

Consumer Reports placed more than 500 calls to 163 pharmacies nationwide to gauge price differences among four prescription drugs, three name brand medicines and one generic.   For a three-month supply of pills for the urinary incontinence drug Detrol, for example, the price ranged from $365 to $551.  CR also found significant price disparities for the two other name-brand drugs it studied: for Plavix (which prevents blood clots), the spread was $382-$541, and for Levoxyl (for treating hypothyroidism), prices ran from $29 to $85.  And for the generic alendronate (for osteoporosis), the price range was $124 to $306.

In CR’s small scale market-basket study, Costco was the cheapest for the four drugs CR sought quotes for, followed by AARP.com and Wal-Mart.    Walgreens and Rite-Aid were among the priciest for the four drugs.

Besides calling different stores and comparison shopping, other cost-saving tips include:

• Don’t rule out independents: Though they’re not the cheapest overall, many mom-and-pop pharmacies are highly competitive and offer top notch service.

• Talk to your employer:  Benefits administrators can provide details about pharmacy benefit managers, also known as PBMs.

• Buy generics: They can cost 20 to 50 percent less than their brand name equivalents.

• See if there’s a discount program: Some stores have programs for those 50 and older; other programs are open to anyone without insurance.

Drugstore Survey: A Shift in Pharmacist Relationship

The Consumer Reports National Research Center surveyed 40,133 readers to find out about their experiences at drugstores. One striking finding: readers sought pharmacists’ advice about prescription drugs at just 38% of walk in visits during the course of a year.  That’s down from 50% since CR’s last survey in 2002.  “That’s a pretty significant shift in the consumer-pharmacist relationship,” said Tod Marks, senior editor at Consumer Reports.

According to recent estimates, in any given week, one-third of adults take five or more medicines or supplements.  And the stakes are high: an estimated 18 million people go to an emergency room every year because they’ve taken medication incorrectly.  “Consumers need to be mindful about the potential for drug interactions that could be dangerous since more people take not only multiple prescription drugs, but also supplements and  over-the-counter remedies too.  Seeking advice from a pharmacist when filling a prescription is a good way to learn about possible adverse reactions and increase the odds that you’re taking the medicine properly,” said Marks.

The survey by the Consumer Reports National Research Center also found that only 33 percent of prescription drug buys were mostly or entirely covered by insurance coverage.  In 2002, the last time CR surveyed readers about their drugstore experiences, 65% of prescription drug buys were covered. “More people are digging deeper and paying a larger share of out-of-pocket costs for prescriptions drugs,” said Marks.

Nowadays, of course, “drugstore” is a misnomer and a wide-range of stores now exists.  CR surveyed its readers to glean the best advice about the multitude of drugstore options, from the mom-and-pop drugstore to the chains on every corner to mass merchants and finally, mail order resources and pharmacy benefit managers.   Here are the choices and how they compare:

Independents: Personal service.  Since 1998, when CR first surveyed readers about their drugstore experiences, the independents have always ranked above the other types of stores. Readers gave pharmacists at independent stores high marks for being accessible, approachable, easy to talk to (when sought out), and knowledgeable about prescription and nonprescription products.  Independents also stock medical supplies that might be missing from other types of stores and will also customize medicines.  Waits were uncommon and many independents offer home delivery.  On their web sites, it’s usually possible to order refills, shop for medical supplies, track purchases, and do research.

Chains: You might have to wait.  Americans still buy most of their medications from conventional chains such as CVS and Walgreens.  They tend to take lots of insurance plans, some never close, and the bigger ones seem to sit on every corner.  At their web sites, consumers can typically create a secure profile, track prescribing history, print records, e-mail questions to the pharmacist, do research, and sign up for automatic refills.  Chains are more likely than other stores to allow people to check prices online. On the down side, more than one in four readers complained about long waits.

Supermarkets: Shop while you wait.  About 10,000 supermarkets include a pharmacy, and some are open 24 hours a day. 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 (one often can’t check prices) but consumers can typically renew, fill, or transfer an existing prescription; research drugs and interactions; and read articles about healthful living and preventing illness. 

Mass merchants: Seek special deals.  Mass-merchants focus on price.  For example, Wal-Mart and Target sell a 30-day supply of more than 300 drugs, primarily generics, for $4 each.  And Kmart offers a free GoldK card to people 50 or older with savings of up to 10 percent on every brand name drug or as much as 20 percent on generics.   Mass-merchant Web sites tend to be similar to supermarket-pharmacy sites.  

Online/mail order: Save on refills.  Some online stores have no store counterpart; others do.  Online orders can usually be picked up at a store of one’s choice or orders can be shipped using standard shipping for little or no extra charge, allowing 5-10 days. Online drugstores will usually let consumers order a 90-day supply of medications for chronic conditions, a service that isn’t as easy to find in walk-in stores.  One note of caution: consumers who are unfamiliar with an online site should be sure it’s licensed in their state.  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.  CR notes that rogue sites have started to pop up, pretending to be based in Canada but actually operating out of Asia or the Middle East, and the quality of the drugs they’re peddling is not guaranteed. 

PBMs: A newer way to save.  Roughly one-quarter of the 57,000 medicine-buying experiences readers told CR about were with PBMs, or pharmacy benefit managers, including Aetna Prescription, Anthem Rx, CaremarkRx (now called CVS Caremark), Express Scripts, and Medco.  These companies, with 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.   PBM members (consumers don’t choose a PBM; their employer does) can buy three-month supplies 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.