[Congressional Record Volume 149, Number 138 (Thursday, October 2, 2003)]
[Senate]
[Pages S12367-S12368]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    INDEPENDENT COMMUNITY PHARMACIES

  Mr. PRYOR. Mr. President, I rise today to acknowledge our Nation's 
independent community pharmacists for their diligent work, expansion of 
services, and consistent high quality service.
  Independent community pharmacies are a strong part of our health care 
delivery system and a significant part of local economies. In fact, 
independent pharmacies, independent pharmacy franchises, and 
independent chains represent a $67 billion marketplace. Clearly, 
independent pharmacies create jobs while providing high quality 
services to consumers.
  Independent community pharmacies play a critical role in local 
communities, a role which has enhanced the level and quality of 
pharmacist-patient personal interactions and has led to high 
satisfaction rates from consumers. Independent pharmacies should be 
commended for their accessibility, immense knowledge about medications, 
and broad inventories of medications. These observations were validated 
by more than 32,000 readers surveyed by Consumer Reports, which found 
that ``more than 85 percent of customers at independent drugstores were 
very satisfied or completely satisfied with their experience.''
  Pharmacists are health care professionals who consistently strive to 
improve care and promote the safe use of drugs. In addition to 
dispensing medications, many independent pharmacies offer other 
services to meet the needs of their customers. This includes providing 
health screenings, disease management information, and even home 
delivery.
  I am honored today to recognize the achievements of independent 
pharmacies for their excellent job in serving the pharmaceutical and 
other health care needs of consumers in their communities. As Congress 
moves forward with enacting a Medicare prescription drug benefit, it is 
essential that we preserve the quality care being provided by community 
pharmacies.
  Mr. President, I ask unanimous consent to print in the Record an 
article from the October 2003 issue of Consumer Reports.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                       Time To Switch Drugstores?

       If you're among the 47 percent of Americans who get 
     medicine from drugstore giants such as CVS, Eckerd, and Rite 
     Aid, here's a prescription: Try shopping somewhere else. The 
     best place to start looking is one of the 25,000 independent 
     pharmacies that are making a comeback throughout the U.S.
       Independent stores, which were edging toward extinction a 
     few years ago, won top honors from Consumer Reports readers, 
     besting the big chains by an eye-popping margin. More than 85 
     percent of customers at independent drugstores were very 
     satisfied or completely satisfied with their experience, 
     compared with 58 percent of chain-drugstore customers.
       Many supermarket and mass-merchant pharmacies also did a 
     better job than the best-known conventional chains at 
     providing caring, courteous, knowledgeable, and timely 
     service. And in a nationwide price study we conducted, the 
     chains we evaluated charged the highest prices--even slightly 
     more than the independents.
       Those findings come from our latest investigation into the 
     best places to shop for prescription medications. More than 
     32,000 readers told us about more than 40,000 experiences at 
     31 national and regional drugstore chains (like CVS, 
     Genovese, Osco, Rite Aid, and Walgreens); supermarket-
     pharmacy combos (such as Kroger, Publix, and Safeway); 
     mass-merchant pharmacies (like Costco, Target, and Wal-
     Mart); and independent pharmacies across the nation.
       For most consumers, insurance covers at least some of the 
     cost of prescription drugs, so our Ratings emphasize service 
     factors that affect everyone. For consumers who have to pay 
     more than a small percentage of their prescription-drug 
     costs, including more than a third of our readers, our price 
     study indicated where to save money. (See Where to shop, how 
     to save.)
       Among the other highlights of our research:
       Some of the drugstore chains and supermarkets that readers 
     favored are family owned or businesses in which workers have 
     a stake. Medicine Shoppe, the top ``chain,'' is actually a 
     collection of about 1,000 individually owned and operated 
     stores with a common parent company. Among supermarkets, 
     high-rated Wegmans (in New Jersey, New York, and 
     Pennsylvania) is family owned; and at high-rated Publix (in 
     the South), most workers are stockholders.
       Forty percent of readers said that at least once during the 
     past year, their drugstore was out of the medicine they 
     needed.
       Our market basket of a month's worth of five widely 
     prescribed medications cost $377 to $555, depending on where 
     we shopped. For a family needing all five drugs, that 
     difference would exceed $2,000 a year.


                         sorting out the stores

       Most people start by searching for a store that accepts 
     their insurance plan. Fortunately, that isn't the hassle it 
     used to be, especially since independents are accepting more 
     plans these days. Insurers once considered the disparate 
     stores too much trouble to work with, but they realized that 
     keeping independents out of their networks alienated 
     customers and didn't cut costs as much as they'd hoped. Also, 
     33 states have adopted ``any willing provider'' laws, which 
     require insurance companies to take into their networks any 
     pharmacy that's willing to accept the insurer's reimbursement 
     rate. As a result, you have a greater choice of where and how 
     to shop.
       The basic choices:
       Independents: Service is all. Prescription drugs are the 
     independents' lifeblood, accounting for 88 percent of sales. 
     That means independents can be a good source of hard-to-find 
     medications. (The chains, where drugs account for 64 percent 
     of sales, tend to focus on the 200 most-prescribed drugs.)
       That focus on prescriptions can mean more personal 
     attention. Readers said that pharmacists at independent 
     stores were accessible, approachable, and easy to talk to, 
     and that they were especially knowledgeable about 
     medications, both prescription and nonprescription.
       The independents (and some chains) offer extras such as 
     disease-management education, in-store health screenings for 
     cholesterol, services such as compounding (customizing 
     medications for patients with special needs), and home 
     delivery.
       Many independents are affiliated with programs such as Good 
     Neighbor or Value-Rite, whose names you'll see in the stores. 
     These ``banner'' programs, offered by wholesale product 
     suppliers, help independents with marketing and with the sale 
     of private-label products, improving purchasing power and 
     name recognition much the way ServiStar and True Value 
     help small hardware stores compete with Home Depot and 
     Lowe's.
       About half of the nation's independents have Web sites, 
     where you can generally order medicine and find some health 
     information but not much more.
       Chains: Convenient but crowded. With about 20,000 stores 
     nationwide, mega-drugstores are in nearly everyone's 
     backyard. Many are open around the clock, have a drive-
     through pharmacy for faster pickup, and let you order online 
     or by punching a few numbers on a telephone. You can even set 
     up your Web account to have renewals automatically processed 
     and readied for pickup or mailing. The biggest chains let you 
     check prices online. Another advantage: The chains accept 
     payment from lots of health plans (managed care pays for 80 
     percent of all conventional-chain prescriptions).
       Now for the drawbacks. The chains' locations in populous 
     areas and their acceptance of a plethora of plans has made 
     them, in effect, too popular, and service is suffering. 
     Except for Medicine Shoppe, chains typically made readers 
     wait longer, were slower to fill orders, and provided less 
     personal attention than other types of drugstores.
       Like other drugstores, the chains have experienced 
     shrinking reimbursement from insurers. They've helped 
     maintain profits by selling everything from milk to Halloween 
     costumes. That makes one-stop shopping possible (if your list 
     isn't too specific), but it also can create bottlenecks at 
     the checkout.
       Supermarkets: One stop does it. There are fewer than 9,000 
     supermarkets that include a pharmacy, but the number is 
     rising. One-stop shopping is the attraction. Many 
     supermarkets put the pharmacy near the entrance for easy 
     access and to attract store traffic. For those very reasons, 
     however, you may not have as much privacy to consult with the 
     druggist as you would elsewhere.
       Supermarkets have online pharmacy sites, usually as a link 
     from the home page, but they're often less comprehensive than 
     those of big drugstore chains.

[[Page S12368]]

       Mass merchants: Low price is key. Like supermarkets, these 
     stores sell a wide variety of goods. But their main draw is 
     low prices. One in five readers who bought medication from a 
     mass merchant had no prescription-drug coverage. In our price 
     study, only Web sites sold medications as cheaply. In our 
     survey, ShopKo and Target were among the high-rated mass 
     merchants; Wal-Mart was worse than most others.
       All of the mass merchants in our survey have Web sites for 
     ordering prescriptions, but only the Costco site lets you 
     check drug prices.
       Online: Low prices, no face time. Virtual pharmacies come 
     in two basic flavors. There are adjuncts to brick-and-mortar 
     stores, where you can order online and receive your 
     prescription by mail or pick it up. Then there are sites such 
     as www.drugstore.com and www.aarppharmacy.com, which have no 
     store and simply mail the medicine to you. With both types of 
     site, you can enter the name and quantity of the drug online; 
     a pharmacist will confirm the prescription with your doctor. 
     (Often, you can fax or mail a paper prescription instead and 
     wait for it to be approved, but that can add days to the 
     process.)
       Anytime you're not picking up from a pharmacist, you lose a 
     chance for personal contact, a consideration if you're using 
     a medication for the first time or are juggling medications. 
     To compensate, the stand-alone Web sites--and those operated 
     by the drug chains and some mass merchants--make it easy to 
     e-mail questions to pharmacists 24/7, research medical 
     topics, search online for potentially dangerous drug 
     interactions, receive e-mail refill reminders, keep track of 
     your medications, and note any drug allergies. Drugstore.com 
     will also alert you if the branded drug you're taking becomes 
     available in generic form.
       It can take as little as a couple of hours for your 
     medicine to be ready if you order from a chain and are 
     willing to retrieve it, or as long as three to five business 
     days if you ask for it to be mailed standard shipping. That's 
     free or nearly so. You can pay about $15 to have medicine 
     overnighted (refrigerated medicines must be sent that way). 
     Web sites can't ship every controlled substance.
       When you use a Web site, you can avoid waiting in line, of 
     course, and you'll tend to pay lower prices, even when 
     shipping costs are included. No computer? No problem. Sites 
     have toll-free numbers.
       Four percent of our readers had bought medications online, 
     most often from drug chains, and three-quarters of those said 
     the transaction went smoothly: Their order was processed 
     quickly enough for their needs, and e-mailed questions were 
     answered promptly. (For details on ordering via the Web, see 
     The online option.)


                         getting better service

       Some stores did far better than others in service, speed, 
     and information provided by the druggist. The most frequent 
     complaints: Drugs were out of stock, readers had to wait a 
     long time for service at the pharmacy counter, and 
     prescriptions weren't ready.
       Drugstore chains and supermarkets were most likely to be 
     out of a requested drug. When a drug was out of stock, 
     independents were able to obtain it within one day 80 percent 
     of the time, vs. about 55 to 60 percent for the other types 
     of stores. Only 9 percent of the time did independent 
     customers have to wait at least three days for an out-of-
     stock drug or find it elsewhere, vs. at least 18 percent of 
     the time for other types of stores.
       Drugs were out of stock more often this time than when we 
     published our last drugstore survey, in 1999. The steepest 
     jump took place at Albertsons, Giant, and Longs Drugs, whose 
     out-of-stocks increased by more than 15 percentage points. 
     That's probably the case in part because the number of 
     prescriptions being written is growing faster than the shelf 
     space.
       Overall, 27 percent of readers complained about long waits. 
     It's no wonder. Pharmacists fill nearly 4 billion 
     prescriptions a year, an average of almost 200 per day for 
     each pharmacist, and spend one-fourth of their time on 
     administrative work such as calling doctors and dealing with 
     insurance companies. Moreover, there's a shortage of 
     druggists--there are approximately 5,500 job openings around 
     the U.S. At CVS, Genovese, Longs Drugs, and Sav-On, about 40 
     percent of readers complained of long waits for service. 
     Lines were short at Medicine Shoppe (only 6 percent of 
     readers complained) and at the independents (8 percent).
       Twenty percent of readers overall said that their 
     prescription wasn't ready when promised. Among the worst 
     offenders: CVS, Genovese, and Rite Aid, where prescriptions 
     weren't ready nearly one-third of the time. Better-prepared 
     stores included Medicine Shoppe, Publix, ShopKo, Winn-Dixie, 
     and the independents.
       Other complaints focused on how pharmacists interact with 
     customers. Worst offenders: the drugstore chains, where 10 
     percent of readers said they did not receive enough personal 
     attention from their pharmacist. Best: You guessed it--the 
     independents--where only 2 percent of readers found fault.
       Service may improve in all stores, eventually. In many 
     states, regulators are giving technicians more authority to 
     assist druggists. Technology is also lending a hand in the 
     form of robotic machines that dispense medications. They do 
     everything but cap the bottle (which goes uncapped to the 
     pharmacist for a final inspection).
       Although only a small fraction of doctors are now writing 
     e-prescriptions, they are the wave of the future. Doctors use 
     a handheld device to transmit your prescription to the 
     drugstore. The procedure avoids one of druggists' biggest 
     problems and a contributor to the rising incidence of drug 
     errors: deciphering doctors' handwriting.
       While waiting for the future, you might improve the odds of 
     getting good service now by patronizing an independent 
     pharmacy. But whatever drugstore you use, you're apt to get 
     better service by following some simple advice:
       Avoid waiting. Order drugs online or by phone, then pick 
     them up (or, if you're not in a rush, have them mailed). If 
     you plan to pick up drugs, check from home whether the doctor 
     and druggist have connected and the prescription is ready.
       Establish a good relationship. Make sure you can step aside 
     and talk privately with the pharmacist and that you can reach 
     him or her by phone. The pharmacist should volunteer details 
     about the drug and be able to answer questions about 
     nonprescription products, too. With online pharmacies, make 
     sure you receive prompt, thorough answers to questions 
     submitted by e-mail.
       Get good advice. Check that the pharmacy keeps and updates 
     your medication records, which should reduce the risk of a 
     drug conflict or adverse reaction. Don't walk away from the 
     counter without knowing the following: what to do if you miss 
     a dose; how many refills are permitted; how to store the drug 
     and when it expires; what side effects to expect, along with 
     which to ignore and which to contact your doctor about; and 
     foods, drugs, supplements, or situations to avoid while 
     taking the medication.

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