[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.
____________________