When it comes to having your prescription filled, you have several sources, or channels, to choose from. Not all channels provide the same level of service or reliability, however, and their prices for your particular medicines may or may not vary. It's important, therefore, to understand the pros and cons of the various outlets and know how to evaluate them before you decide.
If you have any type of prescription insurance, you should inquire ahead of time whether your plan requires you to use a specific network of pharmacies in order to get reimbursed. What it all boils down to is that you have to take the time to evaluate your particular situation, needs, and preferences as well as the drug channels themselves. The following discussion can help you make a more-informed choice.
Of the various drug channels, walk-up, or "brick-and-mortar," pharmacies are the ones that allow you to meet face-to-face with a pharmacist, giving you the chance to take advantage of the full range of benefits that this valued health care partner can provide. When it comes to choosing one of these pharmacies, you should consider several factors.
Convenience is one such factor. If you'll be driving to the pharmacy, for example, you may want to choose one that is conveniently located to your home and has plenty of parking. Some even offer drive-up windows and/or allow you to request a refill in advance, via telephone or Internet, to cut down on wait time. You might also check into one of the pharmacies located in supermarkets, so you can have your prescription filled while you shop.
If you have trouble getting around, you might seek a pharmacy that offers delivery of prescriptions to your home. And if you use one or more nondrug items -- such as ostomy or diabetes supplies -- you should ask if the pharmacy can bill these directly to Medicare or your insurance. Many larger pharmacy chains also offer Web sites that you can access 24 hours a day.
Service is the next factor to consider. Consumer Reports rated pharmacies in 1999 and found that independent pharmacies ranked highest in terms of service, information, and speed compared with drugstore chains, supermarket pharmacies, and mass merchandisers. Survey respondents said independent pharmacists provided more personalized service, were more accessible, kept customers waiting less time, and provided better information about prescription drugs than the competitors in other drug channels. Still, individual drugstores do vary, and you'll need to decide what level of services you require and whether a specific pharmacy can deliver it.
Price is the final factor to consider. In a pricing comparison based on 26 sources of five popular prescription drugs, independent pharmacies were the most expensive. Mail-order and Internet pharmacies charged the lowest prices. Chains, supermarkets, and mass merchants were in between the two ends of the cost spectrum. In some cases, there was as much as a 25 percent price difference for the same medication.
Clearly, then, prices on prescriptions do vary, so if you have the need and desire, you could shop around for the best price on each of your medications. But the disadvantage of pharmacy hopping is that you forfeit the huge advantage of having one pharmacist/pharmacy get to know you and maintain a complete medication record to screen for potential problems.
If you've found a pharmacy that provides the convenience and services you seek but have seen lower prices advertised elsewhere, you could ask if your pharmacy will match the lower prices offered by a competitor. If not, it's still important to place price in perspective, because the cheapest isn't always the best when it comes to taking care of your health. Your aim should be to choose a pharmacy that, overall, provides the convenience, service, and generally low everyday prices you need.
Domestic Mail-Order Pharmacies
If you are on long-term drug therapy, filling your prescriptions through a U.S.-based mail-order pharmacy may be convenient and may save you money. Indeed, some managed care companies require it.
Mail-order pharmacies often offer discounts on medications bought in bulk. So if you take a medication for a chronic condition, such as high blood pressure, you can order a 90-day supply at a lower cost per pill. However, because it can take a few days or even weeks for your medication to arrive, this is not a practical choice when you need a prescription filled quickly for an acute condition (such as an infection or injury).
As with other important choices, you should do your research before choosing a mail-order pharmacy. If possible, get a recommendation from your health care provider, insurance company, or other trusted source.
Make sure the mail-order company offers basic services such as pharmacist consultations, computerized medication records, drug interaction and duplication screening, and refrigeration of transported medicines if required (proper handling can sometimes be hard to verify). Check to make sure the mail-order company will work with your insurance company. Then do a trial run using one of your less-expensive prescriptions; that way, if anything goes wrong, you will not be out too much money.
Test the system: Call and ask to speak with a registered pharmacist to ask a medication question, keep track of how long it takes for the medication to arrive, and do a cost comparison with your local pharmacies. Get a legitimate U.S. street address for the company, not just a Web address, in case there are problems. Make sure your medication can be sent to you overnight in an emergency, even if it costs you extra. Also, ask if you will have to pay an extra shipping charge if one of your drugs is out of stock and must be sent separately.
There are hundreds of drug-dispensing Web sites ready to sell you medical products, often at deep discounts. Some of these are legitimate, but many more operate illegally. The Food and Drug Administration (FDA) cautions that purchasing a medication from an illegal Web site puts you at risk of receiving a contaminated or counterfeit product, the wrong product, an incorrect dose, or no product at all. The result could be dangerous drug interactions or other serious medical problems. In addition, these Web sites may not protect your personal information.
Some sites offer to send you a medication based only on your answers to a questionnaire, without requiring you to visit a doctor for an exam and prescription. The American Medical Association considers this substandard care; just filling out a questionnaire provides insufficient information for a prescriber to determine if a drug is safe and appropriate for you, if another drug would be better, or if an underlying medical condition might make the drug unsafe for you.
Due to an increase in the number of fraudulent Internet pharmacies, FDA concerns, and consumer outrage, steps were taken in 1999 to help consumers locate and safely obtain prescriptions online. The National Association of Boards of Pharmacy (NABP) developed a voluntary program of certification for Internet pharmacies -- called the Verified Internet Pharmacy Practice Sites (VIPPS) program -- to help consumers identify high-quality, legitimate Internet pharmacies.
Pharmacies participating in the program have a VIPPS seal on their Web sites, which links directly to the VIPPS Web site. There, you can verify a pharmacy's certification and obtain additional information about the pharmacy. Currently, 12 Internet pharmacies have been VIPPS-certified. More information regarding the VIPPS program is available at www.nabp.net/vipps/consumer/faq.asp.
Foreign Pharmacies and Drug Sources
There is a growing movement among cash-strapped consumers, particularly the elderly on fixed incomes, to seek out Canadian and other foreign sources of less-expensive prescription medications. The FDA is very concerned about this growing trend as well as the proliferation of online and storefront operations offering to help U.S. consumers obtain medications from these foreign sources. Some of the FDA's major concerns in this regard are summarized below.
Lack of quality assurance. Medications not approved for sale in the United States may suffer from substandard manufacturing practices.
Counterfeit potential. Some drugs imported from foreign countries are actually counterfeits, containing useless or even toxic ingredients.
Presence of untested ingredients. Foreign medicines may contain substances that are not FDA-approved as being safe or effective.
Lack of medical supervision. Drugs are considered "prescription" because they are not safe for you to take on your own. To use the drug safely, you may require regular monitoring of your disease, the level of the drug in your blood, or side effects.
Labeling, information, and language issues. The medication's label may be incomplete, in error, or in a foreign language. That will make it almost impossible for you to take the drug "as directed," because you won't know what the correct, complete directions are.
It's illegal. Under the Federal Food, Drug, and Cosmetic (FD&C) Act, it's illegal to import into the United States any drug that is adulterated, misbranded, or unapproved, which would include the foreign versions of medications that have been approved by the FDA. It is also illegal for anyone other than the drug's manufacturer to re-import a prescription drug that was originally manufactured in the United States.
Recently, the FDA has identified a growing number of online companies that claim to be legally selling Canadian drugs directly to U.S. consumers, but it's not legal. However, a loophole in the law allows consumers to import up to a 90-day supply of medications for personal use only, and Canadian Internet pharmacies have been taking advantage of this loophole for years to sell and export medications to Americans through mail-order and Internet pharmacies.
Likewise, a number of Canadian drug Web sites and ordering services advertise, perhaps in an effort to allay U.S. consumers' fears, that they are dispensing drugs only for existing prescriptions written in the United States that are then rewritten by a Canadian doctor in order to comply with Canadian law. However, prescribing and dispensing medications to a patient sight unseen is against the Canadian Medical Association's Code of Ethics, which states that physicians have a responsibility to do a patient history, conduct a physical exam, and discuss the risks and benefits of the medication with the patient. In many cases, these essential activities simply do not occur.
A hybrid form of foreign-drug distribution has also cropped up in the United States. It consists of storefront operations that offer to facilitate the importation of Canadian drugs by providing the consumer the forms and the guidance to order medications from Canadian pharmacies. The employees of these operations are generally not licensed by a state board of pharmacy and often have no medical background whatsoever. They are simply in business to broker the arrangement between a U.S. consumer and a Canadian pharmacy, which pays a finder's fee to the storefront operation.
The FDA and state boards of pharmacy across the country are of the opinion that when these storefront businesses engage in such activities, they are unlawfully acting as pharmacies. Consumers may get a false sense of safety and legitimacy when ordering foreign drugs through these businesses, since there is an actual business to walk into with staff onsite for assistance. But these storefront operations generally do not guarantee that consumers will get the correct, unadulterated medicines they ordered. What's more, these businesses usually require consumers to sign a waiver releasing the businesses from all liability, so the consumer has little or no recourse should something go wrong.
Still, the problem of seemingly out-of-control drug prices, and the reality that many patients in the United States must choose between using these illegal means to buy their drugs or simply not being able to afford them, has forced the entire issue of drug affordability to the fore. In 2004, the U.S. Department of Health and Human Services Task Force on Drug Importation estimated that the dollar value of imported prescription drugs was $1.4 billion -- about 0.6 percent of total U.S. drug sales. However, if drug importation were to become legal in the United States, it has been suggested that imported prescription drugs could account for 10 to 15 percent of the entire U.S. prescription drug market.
As of this writing, the U.S. Congress is debating the issue of drug importation, pitting the hope of lower prices against the fear of counterfeit drugs. A recent study published in the Annals of Internal Medicine compared the cost of 44 common brand-name drugs sold by 12 Canadian Internet pharmacies and 3 large, U.S.-based "brick-and-mortar" pharmacy chains that also offered Internet pharmacy services. It was found that Americans could save approximately 24 percent if they purchased their prescription drugs from Canadian Internet pharmacies.
The pharmaceutical industry has long argued that not only can it not guarantee the safety of imported medicines, but the higher prices charged in the United States are necessary to fund research and development. They also argue that allowing these drug importations would amount to blocking free trade -- we would, in essence, be importing foreign price controls along with the drugs. And the FDA fears that the measure would threaten patient safety.
Yet busloads of Americans are already buying their medications from foreign countries, either in person, through the mail, or over the Internet, because they can't afford the drug prices in the United States. And consumers -- as well as some lawmakers -- are outraged by cheaper prices in nations such as Canada, whose governments limit drug prices.
Indeed, some government officials at the state and even local levels have suggested programs to save their constituents tax money by reimporting drugs from Canada for select populations, such as government workers who receive drug benefits or inmates in state prisons, despite the federal regulations prohibiting it. So it is hoped that the arguments from both sides can be heard and that eventually some sort of compromise will help to guarantee not only safe but also affordable medicines for all Americans who need them.
For now, however, the bottom line is that you should be wary of foreign sources of prescription medications. You are always safer going the traditional route to get your prescriptions filled -- that is, purchasing your prescriptions through a licensed U.S. pharmacy. In doing so, you will be taking full advantage of the United States' well-developed approval and distribution system for prescription medications, a system that employs the necessary controls to keep your medications safe and effective for you and your family.
We know that this is a lot of information to digest, but there are agencies out there to assist you. On our final page, we will show you some resources you can use to lighten the load of the prescription drug problem.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.