Finding the right pharmacy

"Corner drugstore" may be an apt phrase, because you can hardly turn a corner without running into a CVS, Rite Aid, or Walgreens. The U.S. is home to more than 7,400 CVS stores alone. But if you’re still going to a pharmacy chain for prescriptions, as do half of our readers, you might be missing out. As a group, pharmacy chains scored no higher in our Ratings of walk-in drugstores than big-box chains such as Costco and Walmart, and both types of store were bested by super­markets and independent pharmacies. Independents (and the independently owned franchise chain Health Mart), as well as the regional supermarket Wegmans, earned readers’ top marks for speed and accuracy, courtesy and helpfulness, and pharmacists’ knowledge.

When we spoke to industry insiders, one point became clear: Pharmacies are taking on a bigger role in healthcare. Overall, that’s good news for busy consumers. “It’s not just about filling pill bottles,” says B. Douglas Hoey, CEO of the National Community Pharmacists Association. “Pharmacies are starting to offer more comprehensive services—everything from making sure that the medicines you take are right for you to preventive care and health monitoring.”

That makes it more important than ever to have the right pharmacy and to make a change if you aren’t satisfied with the role yours is playing in your health care. We’ve pulled together a list of 10 reasons to consider switching.

Establishing a good relationship with a pharmacist you trust is the No. 1 reason to choose a drugstore, says Lucinda Maine, CEO and executive vice president of the American Association of Colleges of Pharmacy. “You can and should expect your pharmacist to be both accessible and knowledgeable,” she says. “If he or she is not, then you should take your business elsewhere.”

The vast majority of readers rated their pharmacist’s knowledge as Very Good or Excellent, regardless of the type of pharmacy, but independent drugstores came out on top, with 94 percent of patrons giving their pharmacists high marks. Not surprisingly, customers at independents were much more likely than others to have discussed prescriptions with their pharmacist. That’s especially important because your pharmacist can tell you about ways that over-the-counter drugs and even certain foods can interact with prescription drugs to make them less effective or cause dangerous side effects. Too much vitamin K from leafy greens, for instance, can reduce the blood-thinning effects of warfarin, and certain supplements, including St. John’s wort, can make birth-control pills and some heart drugs less effective.

It can be particularly difficult in large stores to communicate with pharmacists, who are usually busy in the back, leaving technicians and clerks to serve customers. One-third of shoppers at chain pharmacies and big-box stores who said they weren’t comfortable discussing personal medical concerns at the drugstore thought the pharmacist seemed too busy. To counteract that impression, Walgreens has moved a pharmacist to a desk up front in some of its stores.

A lack of privacy was a problem for more than one-third of the readers who felt uncomfortable discussing personal medical concerns with their pharmacist. Such was the case even at independents. Many drugstores have a consultation area; don’t be shy about asking to talk there rather than at the pick-up counter. For longer consultations—say, to review all of your medications or discuss your prescription-drug coverage—you should be able to make an appointment. If you’re unclear about how to take a drug or what to take it with, or you just want to talk privately, a phone call is a great option.

You’re much less likely to wait at an independent pharmacy than at another type of store, according to our survey. Only 7 percent of customers at independents reported that a prescription wasn’t ready when promised during the previous 12 months; just 4 percent complained of long waits. By contrast, 19 percent of shoppers at pharmacy chains found that a prescription wasn’t ready, and 21 percent experienced long waits at the service counter.

Keeping customers waiting is actually part of the marketing strategy at some stores, says Murph Najjar, who spent more than 12 years as a pharmacist at drugstore and grocery chains before establishing the independent Liberty Pharmacy in Austin, Texas. “They’d like you to use that wait time to shop,” he says. “It’s also why the pharmacy is typically located in the far back corner. By making you walk past as many products as possible, they hope to entice you to buy something.”

Overall, almost 40 percent of shoppers reported that a drug they needed was out of stock in the past year. At Albertson’s, the worst offender, 54 percent had that complaint, as did at least 45 percent of shoppers at Jewel-Osco, Kmart, Medicine Shoppe, Rite Aid, Safeway, and Sam’s Club.

Only about 25 percent of customers at Health Mart and 15 percent at Kaiser Permanente complained that a drug was out of stock. As a group, independents were more likely than other types of pharmacies to restock a drug later that same day or the next.

Help! The drug I take is no longer covered.

If a medication you are taking is dropped from your health plan’s formulary (its list of covered drugs), talk to your doctor, who might be able to treat you with a drug from the new formulary. If that’s not possible, petition your insurance company to cover your drug. If it denies your request, appeal. Your pharmacist can also work with you to choose a more affordable drug, substitute a generic, or petition your plan.

The one area in which independent drugstores didn’t do as well as chains was out-of-pocket costs for prescription drugs. Our survey revealed that customers at independents paid a median of about $50 more each year than supermarket and drugstore-chain shoppers and almost $100 more than people who buy at big-box stores.

Of course, for people with health in­surance, the co-pay is usually the same regardless of the pharmacy. But double-check your plan. Some companies have negotiated discounts with “preferred” pharmacies or mail-order plans. Savvy shoppers can save in several other ways:

Speak up. Our secret shoppers have found that when they’ve asked for a better deal, pharmacy staffers have sometimes suggested discounts (such as those for seniors or students) and membership programs. A good pharmacist can help in other ways. “We can look at what you are taking and suggest cheaper alternatives or generic substitutions,” Hoey says. “We can almost always find ways to cut costs.”

Pay cash. Some readers reported saving by not using their insurance on certain drugs. Big chains offer hundreds of generic prescription drugs for as little as $4 monthly or $10 for a three-month supply.

Earn discounts. Shoppers at the big pharmacy chains were most likely to report using loyalty or rewards programs to save money. Once you’ve signed up online or in the store, show your card when buying prescription drugs or other items and accrue points toward discounts, cash back, or other rewards.

Fill 90-day prescriptions. Filling on­going prescriptions for three months instead of one might save you two co-pays.

Shop around if you pay out-of-pocket. Independents might be more willing to negotiate prices because they have more discretion over costs than do other types of store. Earlier studies by Consumer Reports suggest that prices at independent pharmacies may be much higher or much lower than those at chains or big-box stores. To find out, make a few phone calls.

If you or a family member takes multiple medications, ask about refill synchronization. Pharmacies that offer that service can coordinate with your doctors to make sure all of your medications are ready for pickup once monthly or, in some cases, every 90 days. They can also review your medication during a one-on-one consultation to make sure you aren’t duplicating any drugs, taking medications that you no longer need, or experiencing side effects. If needed, the pharmacist can even call your doctor to adjust your drug list or dosing.

“It’s certainly a convenience for the patient, but research shows that it also helps them adhere to their drug regimen,” Hoey says. Only about 10 percent of pharmacies nationwide offer medication synchronization, Hoey adds, but it has been so successful that more are likely to do so.

It’s hard to miss all of the ads for flu shots, but many people don’t realize the array of other immunizations available at drugstores. As at your doctor’s office, the pharmacy will file with your insurance. Plans cover many vaccines with no co-pay, so you might not be charged. Rules vary by state, but drugstores might offer vaccinations for chicken pox, hepatitis A and B, the human papillomavirus (HPV), measles, pertussis (whooping cough), pneumonia, polio, shingles, and tetanus. Stores that provide travel immunizations, including Target and Walgreens, also cover vaccines for meningitis, typhoid, and other diseases.

Some pharmacies offer health and wellness programs. For example, Walgreens will perform a weight analysis based on waist circumference, body mass index, and body composition (percentage of body fat and skeletal muscle). Kroger pharmacies and others offer smoking-cessation programs. If you try one, be sure that the pharmacist is certified and trained to provide such counseling, and let your doctor know that you’ve entered the program.

Increasingly, pharmacies are contributing to primary care. “The pharmacy is stepping in to fill gaps in therapy,” says Kathleen Jaeger, spokeswoman for the National Association of Chain Drug Stores. “So in addition to making sure patients are taking their medications safely and consistently, you might have the pharmacist working with the primary physician to do routine testing, keeping tabs on things like blood pressure, cholesterol, and blood sugar.” For patients, it can be more convenient to visit a neighborhood pharmacy for tests than to make a trip to the doctor.

A study in Asheville, N.C., found that most patients with diabetes who received ongoing care from their pharmacist had lower hemoglobin A1c levels and fewer sick days, and spent less on hospital stays. For diabetes monitoring, rely on pharmacists who are accredited in diabetes self-management training and education.

Costco and many other drugstores offer periodic screening for heart disease, high blood pressure, elevated cholesterol, type 2 diabetes, and even asthma and chronic obstructive pulmonary disease.

The key to using any of those services wisely is to keep your doctor in the loop, says Marvin M. Lipman, M.D., chief medical adviser to Consumer Reports: “Make sure your pharmacist forwards any information about tests to your doctor’s office so that it can be added to your file. And always follow up with your physician to discuss diagnosis or possible treatment.”

When it comes to ordering prescriptions or refills from walk-in pharmacies, our readers are old school. Almost all said they phoned or faxed orders, had their doctor do it, or visited the pharmacy in person. If you’d rather use your computer, tablet, or smart phone, look for a chain that has integrated those technologies into the pharmacy experience.

Although independent stores are less likely than other types to have an interactive website, most chains will let you handle the majority of your business online. You can check the number of refills remaining, place orders, and designate a time for pickup. You can also sign up to have the pharmacy refill your prescriptions automatically and notify you when they’re ready.

And, of course, there’s an app for that. For example, CVS and Walgreens have mobile apps that let you order refills by scanning the pill bottle with your smart phone. Other nice features: The CVS app will allow you to identify a drug based on its color, shape, and imprint, and check drug interactions on OTC products; the Walgreens app lets you chat with a pharmacy expert 24 hours a day.

Do you ever forget to take medications? Walmart, Sam’s Club, and some independent drugstores will put your pills in blister packs, so you can tell at a glance that a dose has been taken. Jaeger suggests asking the pharmacist to package pills according to when they need to be taken. “We can group them,” she notes, “so instead of a bunch of pill bottles, you’ll have individual packages, neatly labeled with the contents and time of day to take them—breakfast meds and bedtime meds, for example.”

Most independents offer compounding, or custom-mixing, services to tailor medication for individual patients. They can make a medication without a certain dye for a patient with an allergy, for example, or create a liquid version of a drug for a patient who has trouble swallowing pills. Independents also usually stock specialized medical items such as walkers, canes, oxygen, and ostomy supplies.

Facing stiff competition, some drugstores have started to offer delivery services, as in days of old. Some H-E-B pharmacies deliver one prescription for $5 (two or more are free), but the service isn’t available on weekends or holidays. Independents are still your best bet for anytime delivery.

Ordering by mail is another option, and 36 percent of all survey respondents bought prescription drugs from a mail-order pharmacy during the previous 12 months. Nine of 10 did so from an employer- or insurance-managed pharmacy benefit management program such as Express Scripts or Caremark. Relatively few bought from online-only pharmacies such as Drugstore.com or the websites of walk-in pharmacies.

Although ordering by mail can be convenient, it’s less personal and can lead to errors in communication. Even after you’ve discontinued a drug, for example, a mail-order company might keep sending and charging for refills until you tell it to stop. As of Jan. 1, 2014, the Centers for Medicare & Medicaid Services required mail-order pharmacies to obtain consent from a patient or caregiver before shipping a new prescription or refill.

Before using an online-only site, look for a Verified Internet Pharmacy Practice Sites (VIPPS) seal, indicating completion of a voluntary accreditation program through the National Association of Boards of Pharmacy. You can also find accredited sites at legitscript.com.

The choice? Independent drugstore
 

Independents scored highest in every area of customer service. At least 90 percent of shoppers at independents rated their pharmacy as Excellent or Very Good in speed & accuracy, courtesy & helpfulness, and pharmacists' knowledge.

The choice? Pharmacy chain

Shoppers at pharmacy chains were far more likely to use store loyalty cards than were those who shopped elsewhere, and 87 percent of those who did so reported saving money.

The choice? Supermarket chain
 

People who switched to a supermarket pharmacy, from either a different type of drugstore or another supermarket, were most likely to list convenience as a reason.

The choice? Big-box chain

Almost half of our readers who switched to a big-box pharmacy said they did so for better prices on prescription drugs. Our survey found that, on average, big-box customers spent the least out-of-pocket on medications.

The choice? Mail order, maybe

Mail order can make sense if you want your drugs to come to you. But be aware that there have been some complaints about service. If possible, choose a mail-order company that confirms orders before shipping.

Tips for making the switch

Changing pharmacies isn’t difficult, but you need to follow all of the steps to make sure that everyone involved in your family’s health care has up-to-date information. Here’s what to do.

Let the new druggist handle transfers. Much of the work to transfer prescriptions, including remaining refills, is done electronically these days. Depending on your state laws, refills for controlled substances might not transfer, in which case you’ll need to have your doctor issue a new prescription.

Do the paperwork. Your pharmacy needs a complete profile of every family member, including insurance information, medical history, and a list of every drug used—prescription and over-the-counter drugs, herbs, supplements, topical preparations, and even eye drops.

Notify your doctors. It will save time and confusion later if you call your doctors’ offices and update the pharmacy information in your file.

Fill all prescriptions at the new store. Chain stores frequently entice customers with discounts and gift cards for transferring or bringing in a new prescription. But once you’ve found a drugstore that suits your needs, it’s safest to fill all of your prescriptions there if  you can. “Jumping around might save you a few dollars here or there, but it’s bad in the long run because no one place will have a complete medical profile,” Hoey says. “We can’t alert you to potentially dangerous interactions if we don’t know everything you are taking.”

This article also appeared in the March 2014 issue of Consumer Reports magazine. This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2007-2013 Consumers Union of U.S.