Pharmacy Prices & Risks: Hidden Dangers & Deceptive Practices Revealed
Alexa Ray Joel, the daughter of singer Billy Joel, is staying with her father after a recent overdose, according to Block Club Chicago.
The incident highlights ongoing concerns about prescription drug pricing, pharmacy practices, and patient safety, issues that have been scrutinized for over two decades. In 2000, a Newsday investigation revealed significant price discrepancies for the same medications at different pharmacies in New York City. Thirty tablets of Claritin, an allergy medication, sold for $72.99 at Value Drugs, while the same quantity cost $82.49 at Duane Reade – a 13% difference.
Pharmacists attributed these variations to differing business costs, such as rent. However, Larry Sassich, a pharmacist and researcher with the Public Citizens Health Research Group, explained that pharmacies adjust prices based on insurance coverage. Pharmacies with a higher percentage of insured customers often shift costs to those paying full price, including seniors on Medicare and low-income individuals. “Pharmacists can’t push around a big HMO,” Sassich said, “but they can push around a little old lady.”
Florida’s Attorney General’s office previously pursued legal action against Rite Aid for allegedly raising prices for uninsured customers. While the initial charges were dismissed, the state filed for a rehearing, arguing the practice was unethical. Rite Aid maintained its pricing was legal and consistent with industry standards.
The increasing volume of prescriptions filled further exacerbates pressures within the pharmacy system. In 1998, pharmacists filled 2.5 billion prescriptions, a number projected to exceed 4 billion by 2005. Frederick Mayer, president and CEO of the Pharmacists Planning Service in California, noted that managed care incentivized doctors to prescribe medication to expedite patient visits. This increased workload placed significant stress on pharmacists, with some regularly filling twice the recommended 15 prescriptions per hour.
This rapid pace often compromises patient counseling, which is legally required with each prescription. An undercover operation by the New Jersey Division of Consumer Affairs found that nearly one-third of pharmacists were not complying with this requirement. The pressure also contributes to prescription errors. In California, 359 complaints of prescription errors were filed with the state Pharmacy Board in 1999, including an incident where a man was mistakenly given an antidepressant instead of penicillin.
Concerns extend to the growing popularity of herbal remedies sold alongside prescription drugs. Brett Kay of the National Consumers League in Washington, D.C., pointed out that pharmacy computer systems often lack the software to identify potentially harmful interactions between drugs and herbal supplements. Even when pharmacists are aware of both, they may not recognize the risks, such as the increased risk of internal bleeding and stroke when ginkgo is taken with the blood thinner Coumadin.
Financial incentives also influence pharmacist behavior. Pharmacists frequently receive payments for switching patients to less expensive medications favored by HMOs, sometimes even contacting doctors to request prescription modifications. Dr. Martin D. Trichtinger, an internist in Pennsylvania, received as many as 15 such requests daily, some of which he believed could have been detrimental to patient health.
Patient privacy is also at risk. In 1997, a woman on Long Island, New York, discovered her husband had obtained information about her mental health medications through a letter from a pharmaceutical company, which he then used in a divorce and custody battle. Jeffrey R. Krinsk, an attorney, filed a class action lawsuit against CVS Pharmacies, alleging that patient records were improperly shared. CVS denied the allegations.
Instances of deceptive practices, such as pharmacists selling discounted drug samples obtained from doctors at retail prices, and charging insurance co-payments even when the retail price is lower, have also been documented. The illegal diversion of discounted drugs intended for nursing homes to retail pharmacies, resulting in consumers receiving expired or improperly stored medications, remains a problem.
The practice of compounding medications – creating customized dosages or formulations – also carries risks. While safe when performed correctly, some pharmacists compound existing drugs to increase profits, potentially creating versions that are weaker or more potent than intended.
The availability of prescription drugs online presents additional dangers, with numerous dubious websites offering medications without requiring a valid prescription. Mark Herr of the New Jersey Division of Consumer Affairs warned that purchasing drugs like Viagra online without a doctor’s supervision can be life-threatening for individuals with pre-existing heart conditions.