Thursday, June 17, 2010

Why I Hate $4 Prescriptions

Yeah, they steal my business. Yeah, they cheapen my profession. Blah, blah, blah. The real reason I hate them is that they undermine patient safety by promoting the use of multiple pharmacies. I got a call from a woman whose husband was "out of it" and "running into the walls." She wanted to know if the new antibiotic he had started could cause that. I start asking questions. He gets all his prescriptions with us, but he decided to get this new prescription for an antibiotic filled at a grocery store chain that charged him only $4. I check his profile. He happens to be on Tegretol, an anti-seizure medication. He has been stable on it for several years. The antibiotic that was prescribed? Erythromycin. Which dramatically reduces his body's ability to process the Tegretol, essentially causing a Tegretol overdose. Which causes things guessed it...acting "out of it" and having difficulty with coordination...AKA "running into walls." Even if this patient had filled this at another pharmacy and used his insurance, the interaction would likely have been caught through a message from his insurance company. But the $4 prescriptions are promoted as the "usual and customary" price, and are given to everyone without billing insurance. Erythromycin is cheap as hell, and he probably wouldn't have paid more than $10 for it anyway...was it worth it?

I wonder sometimes how the pharmacists who work for these $4 companies feel? Does it change their practice? Are they more careful about asking what other meds the patient may be taking? Or is it "not my problem"? I would love to hear your point of view. I can only hope that the prescriber inquired about other medications the patient was taking, but that doesn't guarantee that the interaction would have been caught. I advised that the patient should stop the antibiotic and contact his doctor. And to call and ask us if there would be an interaction if they chose to go the $4 route again. People, I don't care if you fill it at my pharmacy or not...I just want you to be safe.


  1. I'd say you're right to be concerned.
    The one time I filled a prescription at a $4 place, it was for convenience of location, not price (saved me two hours on the road). I took with me a typed list of my six other prescriptions and gave it to the clerk when she asked if I was taking any other meds. She glanced at my list, looked at me like I was crazy (even though none of the meds are for psych issues), and handed it back to me. The pharmacist never even knew about it.

  2. Wow! Hadn't thought about that angle.

  3. dealers will be dealers. will the real pharmacist please stand up?