Is Loyalty to Your Pharmacy Misplaced?

I recall trips as a youngster to Mack Drugs, our local pharmacy in upstate New York. Preceding the trip, the doctor would tear off a hand-written prescription from his desk-top pad, place it in mom’s fingers and off we would march.  With the little scribbled paper gingerly protected, we drove to the same pharmacy we always patronized. There were other shops in town, nevertheless no question where we were going. Neither was there consideration that the costs might be significantly different somewhere else. We pledged unspoken loyalty to Mack Drugs. But that was ‘long ago and far away.’ These days customers need to demonstrate savvy skills, and perhaps less allegiance.

I rarely visit a drug store other than for household goods, shampoo or other sundries. Yet, I realized it was time. I needed to refill a long-overdue epinephrine product for bee allergies. It was hard to miss the related headline in the news, so you are most likely aware of the “Epi-pen” mark-ups. Amplified prices driven by the disreputable villain who smirked before Congress that it was his right to raise the price as much as he wished. Thus, during 2016, the cost for a one-time auto-injector application of the drug was over $500, and if your luck held out, a 2-pack could be obtained for $650-700. The expiration for each auto-injector is one-year.

Off-track to our subject, but most schools are obligated to always have a least one (1) unexpired shot on hand. Consider the tax dollars of THAT bill.

While I am cautious when outdoors, I was well aware that I needed a new kit. Embarrassingly, mine was years expired. However, between the obnoxious attitude of the Epi-pen owner and the overpriced ‘pen’, I avoided the purchase. In order that you get the full picture, let me explain that a small vial of epinephrine (without the delivery system or needle) is worth somewhere between $2-15 (according to a pharmacist-acquaintance no longer in practice).

It was research time, and my research ultimately proved valuable. Worthwhile for anyone who is susceptible to allergic reactions. After reading on numerous medical sites, I found an alternative to Epi-pen called “Adrenaclick.” Even better, I found a manufacturer’s coupon for a 75% discount, valid until December 2019. [The coupon remains easy to find online by searching for “Adrenaclick” and “coupon.”] I am NOT attempting a commercial either for Adrenaclick or for any particular drug store, but I think you will find this particular situation brow-raising.

My health care provider wasn’t aware of this Epi-pen alternative. I shared my Word file of the bits and pieces I had collected so that she was comfortable prescribing it. No little piece of paper in hand however. As is customary these days, she wanted to phone the script into “my pharmacy.” Not having designated a pharmacy, it was time for my own phone calls.

I hunted down the phone numbers for six locations: choosing 3 in my town and 3 in the next city with more ‘big box’ accommodations. Since shops in other geographical areas may be different or change in the future, I can only recount my experience in mid-2017. To each person who answered my call, I explained the product as “an epinephrine auto-injector treatment, and a less-expensive alternative to the Epi-pen.” I am summarizing my exchanges below.

  1. I hoped to give my business to the smaller, local town drug store, and so phoned the folks there first. After the compulsory “look up” time, I was told, “no, we don’t carry that…and doesn’t look like we can order it.” The person was courteous but showed no further interest or effort.
  2. The local Rite-Aid informed me that they “probably” could fill the script and “probably” could honor the coupon. While saying she could not give me an exact price quote until she had “all the paperwork in front of her,” she thought that the cash price would (probably?) be around $517. (Well, that’s fairly exact). I forgot to verify if this was for a single application or a box of multiple pens. With the 75% discount, I figured the product would ‘probably’ cost me $130.
  3. My conversation with the Northwest co-op store, Bi-Mart, was unproductive but pleasant. They didn’t carry it, but the pharmacist showed interest in looking into it further. She took notes, and thanked me for the information.
  4. The Walgreen’s employee that I happened to encounter was clearly the least interested of all and simply confirmed (in an abrupt, snarky manner) that they don’t carry it. oooooh-kaaay. Having a bad day?

  5. Next was one of the two near-by Walmart Pharmacies. I was pleased when a few years ago, WM established a cost-effective prescription plan even for those without insurance. So, I didn’t mind considering them for this purpose. After my practiced explanation and wait on hold, she confirmed that “yes they could order Adrenaclick.” I asked the cash price. Without a dip or rise in voice tone, she said “that will be $5,802.28.” Whether it was more a screech or a hoot that accompanied my gasp, I stammered “Wwwhat?” She repeated the figure. It may be off by a few cents since my pen was shaking due to shock. Still, she verified the same amount.
    — Me: “you said thousands as in five thousand?”
    — She: “yes.”
    — Me: “You can’t be serious….. is that for a big box or something?.…. could it be a typo?”
    — She: “No, it says for one pen…. Well, some drug solutions are stronger than others, or sold at higher doses, perhaps that is the reason.”
    — Me: “I doubt it, these are generic one-time applications.”
    — She: “Well, there is another one here for $588.”
    Yes, I imaged that indeed there was. ‘Glad that showed up,’ I thought sarcastically. Fortunately, if the dollar figure sent one into shock, treatment would be readily available – at least with a small bank loan.
    She confirmed they would redeem the manufacturer’s coupon. My cost might be $147 – a price that didn’t astound me at any rate. I sure wouldn’t want to be the unlucky individual or insurance company that received the 5K bill (even if by mistake).
  6. CVS was the only pharmacy I didn’t have to explain details to and immediately recognized the product. Additionally, the phone representative assured me not only would they honor my coupon, but that the store had one of their own I could use. He mentioned that it still might be “cheaper using insurance,” but that my cost for a 2-pack would be $55-60. He couldn’t remember “the exact figure off the top of his head” but offered to look it up if I needed. “That’s okay.” Smiles ensued on my end of the phone.
    To fast forward, when I arrived, the coupon was already applied and my final cost for two vials was $54.99. I asked for some time with the pharmacist and expressed my praise to her. She said they “simply wanted to accommodate their customers when they learned of this alternative.” We commiserated about the morals of the situation a bit.

Remember I said this is not a commercial for CVS. I have no idea whether the store would rank at the top or bottom for the next prescription. And there is the problem. Who knows?  There is no certainty, at least without vigilance.

Interestingly, when I called my health care provider to inform the office I wanted the script sent to CVS, the office manager was surprised that I had already confirmed availability. Evidently, patients normally use “their” pharmacy and do little homework before the doctor calls in their prescription. That may be a mistake.

I endorse the theme of “Think Globally, Act (or Shop) Locally.” Yet, the pharmaceutical industry may be a different game. Further, the rules of that game are not clear, nor are they likely in your favor. To get ahead in the ‘game,’ realize that strict loyalty to your pharmacy may be misplaced – and costing you more than you might guess.

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Picture credit: title pic: Hayleybarcar 1454512_1920 via Pixabay; other: moakets 218692_1920 via Pixabay.

 

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