Sunday, June 03, 2007


For several years I've suffered from migraine headaches, for which I take a combination of prescription medications. While I'm relieved that my doctor has found a solution that's worked, I'm struck, each time I have to refill one of the three prescriptions I use, by how expensive the drugs are.

I'm not alone. Last year U.S. sales of prescription drugs reached $274.9 billion, according to IMS Health, a health-care-information company (IMS Reports U.S. Prescription Sales Jump 8.3 Percent in 2006, to $274.9 Billion ). In Canada, according to the Canadian Institute for Health Information, the price tag was $21.1 billion. (Prescribed drug spending expected to surpass $21 billion in 2006.)

I'm fortunate to have health insurance that covers the bulk of the cost of my medicines, even though the amount I must pay as a co-payment increases regularly. Not everyone is as fortunate.

It's no wonder that consumers are looking for any break they can get on their prescription-drug costs.

Carla Hamilton of Orange County, Calif., believes that she's found a way to offset some of her prescription-drug costs by taking advantage of a promotion run regularly by drugstores in her area: If you bring a new or transferred prescription to their pharmacy, they'll give you an in-store gift card that ranges in value from $10 to $30, depending upon the promotion. Customers can take advantage of the offer only once, however, during any six-month period.

Since three different drugstore chains in Hamilton's area make the gift-card offer, she figures that she could rotate her prescriptions among the offering pharmacies at least six times during a 12-month period to take advantage of the promotion.

Hamilton knows that she can do this legally, without violating the restrictions on the promotion, but she wants to know if taking advantage of the promotion in this way would be ethically wrong.

The drugstores that run the gift-card promotions are obviously hoping to lure new customers away from their competitors. Ideally these customers would keep bringing their prescriptions to the pharmacy long after they had received and spent their gift cards. Making the gift cards usable only in that particular drugstore is another way of getting the customers into the store to "test drive" the store.

Hamilton's doubts may stem from a sense of loyalty to the drugstore that gave her something to switch to it, but the implied deal between her and the store extends no further than her receiving and using the gift card. The card is intended to get her to give the store a try, and that's what she does by using it. Thereafter she is free to stay or to go elsewhere as she wishes -- especially since the prescription drugs that she buys are exactly the same regardless of which pharmacy she patronizes.

The right thing for Hamilton to do is to comply with any restrictions that the drugstores have placed on their promotions. That's all she owes them.

There is nothing wrong in her taking full advantage of every gift-card offer she can find. If she can find a way to time her prescriptions so as to save $10 to $30 as often as six times a year, that's simply smart shopping. Even better would be if there were more drugstores in her area offering such deals, so that she could switch her prescriptions every month and offset even more of her prescription-drug costs.


Anonymous said...

Mr. Seglin,
I just finished reading your advice to Carla Hamilton regarding continuously switching prescription drugs. I am a pharmacist and while I currently do not practice in a retail setting, I have for several years. My current practice is with long-term care residents. My concern with frequently switching prescription drugs is that the pharmacies may never have a complete and current list of the patient's medications. This practice bypasses an important step in the health care process; evaluating drug - drug interactions. Eventually she will most likely be prescribed a new maintenance drug or an antibiotic which may interact with her current drug regimen. If she is taking a drug which has a narrow therapeutic window (slightly higher levels could lead to toxicity, lower levels to ineffectiveness), there is always a chance for a dangerous and even deadly interaction. Prior to giving your advice to switch pharmacies every month if possible, it would have been prudent and ethical to inform your readers of the potential danger. I sincerely hope you do so in your next article.
Thank you,
Patti Morris R.Ph.

Anonymous said...

Mr. Seglin, I just read your article about switching drugstores for a gift card, and I could not disagree with you more. I'm a pharmacist, and the Executive Director of the Ohio Pharmacists Association. Your advice will
lead to problems for many of the people that take many meds. First, the average pharmacist in a community pharmacy catches and corrects 3 errors or problems PER DAY that prescribers make on prescriptions. Of the three errors
we catch per day, one-third of them would have caused injury or death, had the pharmacist not caught it. These problems can include serious drug interactions, overdoses, wrong drug prescribed, and many other problems. We
now have dentists, nurse practitioners, physician assistants, and a wide variety of physicians who prescribe. When the patient bounces from pharmacy
to pharmacy for the cards, they put their health at risk. The patient who goes from place to place will not have all drugs on record, leaving them open to errors in our drug assessment. In addition, each prescription
transfer involves its own risks. Many drugs sound alike, and a transfer made over the phone can involve misinterpretation. All it takes is a strong accent to make the process difficult.

People should choose their pharmacist as carefully as they choose their physician. Over 50% of people are taking their medications incorrectly, resulting in 10% of all hospital admissions. Pharmacists are now being incentivized to take more time counseling patients with multiple medications and disease states. Insurers are finding dramatic drops in hospitalizations
amoung those who regularly discuss medications with their pharmacist.

Again, it seems that you are relatively young and healthy, and probably take few drugs beyond the migraine medications. However, you need to be especially careful with those, since they can have serious interactions. Its the frail population, often who take 10 or more medications, who are
most at risk from pharmacy shopping. Here's the advice I'd give them to cut costs:

First, find a pharmacist who will take time to talk to you about all your prescriptions. Bring in all your medications, both prescription and OTC to talk about them. There may be an additional charge for the service.

Secondly, ask the pharmacist if you are taking any expensive brand name drugs that have generic drugs available in the same category. In other words, if you take an expensive arthritis medication that has a high copay or high cost, it is very likely that the pharmacist could identify a
medication costing much less to recommend to your physician. It makes much more sense than having people see the latest high priced drug on TV, ask their doc for it the next week, and then complain that they can't afford the drug.

Pharmacists are key to peoples good health. They are more important than the drug in most cases, since the pharmacist can help the patient and physician find the best drug at the lowest cost. And, more importantly, the
pharmacist's clinical skills are underutilized by the average patient. Most people are unaware that all pharmacy degrees are now a 6 year minimum of study, resulting in a doctor of pharmacy degree. Pharmacists are the most
available health care professional, with most stores offering night, weekend and holiday service. Too often people think that as long as they get the
pills, they are getting all they need. Nonprescription drugs can interact very seriously with prescription drugs, and require discussion between the patient and the pharmacist.

Thanks for listening. I know that competitors are making the switch idea seem like a good one, but its a clinical problem. Generics are largely the answer, since the average generic costs less than $20 per month, while the average brand runs about $130. Looking at the larger picture, one serious
error caused by communication could wipe out any savings for a long time.

Ernest Boyd, R.Ph.
Executive Director
Ohio Pharmacists Association

Anonymous said...

Concerning the patient/shopper who transfers precriptions to get a gift card: What you have failed to acknowledge is the extraordinary care that pharmacists provide in reviewing their patient's medications and drug to drug interactions. If one goes from store to store, no one pharmacist has the opportunity to see the patient's complete drug profile. In my 29 years of practicing pharmacy, I have intervened on behalf of my patients many times and improved their health care.
Elizabeth Boster, R.Ph.
Columbus, Ohio

Anonymous said...

Mr. Seglin:

As a pharmacist, I am very disturbed that anyone would give the advice to switch pharmacies monthly. The job of a pharmacist is not only to fill a prescription quickly and accurately, but also to monitor and manage the pharmacy profiles of its patients. Many patients today do not see their
physicians on a regular basis, and instead rely on pharmacies to call for refills, without a visit. We may be the health care provider that has both the first line and most frequent interactions with patients. Pharmacists monitor for refills that are too soon, drug interactions, and duplicate therapies that can not be seen if a patient is jumping from one pharmacy to another. On many occasions, patients see multiple physicians who write scripts not knowing what the patient is already taking. If a patient brings both to me, i can intervene. If the patient takes one to another pharmacy, neither the other pharmacist nor myself can identify the problem. This
happens on a daily basis. Patients should find a pharmacy, stick with it, and build a patient/provider relationship with the pharmacist. Gift cards may help diffuse high prices, but at what cost?

Luke Slater, Pharm.D.

Anonymous said...

Your article was very bad advice. People need to keep their prescriptions at one pharmacy. The pharmacist can watch for dangerous drug interactions. Having a good relationship with your pharmacist gives you someone to discuss side effects and symptoms. As a retail pharmacist, I often noticed patients taking over the counter meds that interacted with their prescriptions, or taking for example laxatives which indicated they were suffering a side effect from a prescription... A patient who has prescriptions at several different pharmacies is putting their health at risk. Your advice to bounce around for a few dollars in rebates does not make good health sense.

Laura Warner, RPh

Unknown said...

I believe the pharmacist is at fault.If they educated their customers, people would know enough to have their drugs monitored.I being a pharmacist recognize these and other shortcomings.
H. Kasser