James Carter Senior News Editor

When it comes to pharmacies, many consumers expect uniformity: the same prescription should yield the same price and quality, regardless of where it’s filled. However, this expectation is often shattered by the realities of the pharmacy business. For instance, a comparison of prices at various pharmacies in New York’s Greenwich Village revealed significant discrepancies. In early July 2000, 30 tablets of Claritin were priced at $72.99 at Value Drugs, but the same order cost $82.49 at Duane Reade, highlighting a 13% difference.

Such inconsistencies stem from a variety of factors, including the cost of doing business in different locations. According to Larry Sassich, a pharmacist affiliated with the Public Citizens Health Research Group, the break-even costs at pharmacies fluctuate based on the proportion of prescriptions covered by insurance. In pharmacies that cater heavily to insured customers, the costs shift to uninsured patients, often impacting the elderly or low-income individuals who pay full price. “Pharmacists can’t push around a big HMO,” Sassich noted, “but they can push around a little old lady.” This issue has led to legal scrutiny, including a recent case in Florida where Rite Aid faced accusations of inflating prices for uninsured customers.

the overwhelming workload of pharmacists contributes to these challenges. In 1998, pharmacists filled approximately 2.5 billion prescriptions, with expectations that this number would surpass 4 billion by 2005. Frederick Mayer, a veteran pharmacist in California, explained that managed care pushes doctors to prescribe medication quickly to move patients through appointments. Many pharmacists find themselves overworked, often filling prescriptions at rates that can exceed the recommended maximum of 15 per hour.

This frantic pace can lead to mistakes, as seen in the case of a 20-year-old in California who was mistakenly given Zoloft instead of penicillin, resulting in severe illness. Such errors are not isolated; in California alone, there were 359 complaints about prescription errors filed with the state Pharmacy Board in 1999. The industry blames these mistakes on long hours, high stress, and insufficient staffing.

Common Misconceptions and Hidden Practices

Pharmacists often face situations where they may not fully understand the products they sell. With the increasing interest in alternative medicine, many pharmacies now stock herbal remedies alongside prescription medications. However, Brett Kay from the National Consumers League pointed out that many pharmacy computer systems do not include herbal medicines in their drug interaction databases, potentially leading to dangerous combinations. For example, taking ginkgo with blood thinners like Coumadin can significantly increase the risk of internal bleeding.

pharmacists may rely on financial incentives to encourage patients to switch medications, a practice that raises ethical concerns. Dr. Martin D. Trichtinger, an internist, noted he receives multiple requests daily from pharmacists to switch patients to different drugs, sometimes without medical justification. This practice can pose serious risks to patient health.

Another alarming reality is that patients’ private health records can be vulnerable to breaches. A notable example occurred in 1997 when a Long Island woman found her sensitive medical information disclosed during a divorce, allegedly obtained from her pharmacist. Such situations have led to class action lawsuits against pharmacies for mishandling patient data, although companies like CVS have contested these claims.

Legal and Ethical Concerns in Pharmacy

The rise of managed care has made medications more accessible for many, but it has also prompted some pharmacists to engage in questionable practices to increase profits. For instance, Jim Sheehan, an assistant U.S. Attorney, encountered a pharmacist who offered to fill a prescription immediately for cash but suggested that using insurance would delay the process. Such tactics can exploit patients’ lack of knowledge about medication pricing.

the issue of drug diversion poses a significant threat to consumer safety. Criminal organizations have been known to buy discounted medications intended for nursing homes, which can lead to expired or improperly stored drugs reaching retail pharmacies. Chris Whitley from the U.S. Attorney’s office in Kansas City explained that these practices not only jeopardize patient health but can also raise overall drug costs.

Compounding and Online Pharmacies

Pharmacists are also capable of compounding medications, creating custom formulations for patients. While this can be beneficial, some pharmacists may opt to compound existing medications, which can compromise safety and effectiveness. Larry Sassich warns that compounded versions often do not adhere to strict manufacturing guidelines, and patients are advised to prefer commercially available products whenever possible.

In today’s digital age, purchasing medications online has become increasingly common. However, many consumers may unknowingly turn to illegitimate websites that sell medications without prescriptions. While some online pharmacies are reputable, others may offer dangerous drugs without proper medical oversight. New Jersey’s Mark Herr cautioned against purchasing medications like Viagra online without a prescription, emphasizing the potential health risks involved.

As consumers navigate the complexities of pharmacy practices, awareness of these hidden truths can empower them to make informed decisions about their health. Understanding the challenges pharmacists face, the ethical dilemmas they encounter, and the potential risks associated with medications can help patients advocate for their own health more effectively.

As the landscape of healthcare continues to evolve, it’s essential for patients to remain vigilant about their prescriptions and the practices of their pharmacists. Engaging in open conversations with healthcare providers and being aware of one’s rights can lead to safer and more effective treatment outcomes.

We encourage readers to share their thoughts and experiences in the comments below.