As community pharmacists, it is common sense to inform patients about the importance of filling all of their prescriptions at one pharmacy, preferably our own. We often give this recommendation without a second thought about why patients would be using multiple pharmacies, or switching from one to another in the first place. In addition to telling patients to use one pharmacy, it is important to address the underlying issues of why they are not.
Regardless of your opinion on the Affordable Care Act (ACA), and whether it has expanded healthcare accessibility, it cannot be argued that a large number of plans available in the marketplace have high deductibles and exorbitant out-of-pocket costs for patients. One touted benefit of the ACA plans was increased consumerism in healthcare. High deductibles do incentivize patients to hunt for the best costs, but to what detriment? Shopping for the best medication prices means that patients may patronize more than one retail pharmacy, thus increasing their potential exposure to missed drug–drug interactions or duplicate therapies.
A Disadvantageous ChangeRapidly changing preferred pharmacy networks also incentivize the use of multiple pharmacies, or a change in pharmacy altogether. Although using multiple pharmacies is often more detrimental to a patient, switching pharmacies can also pose a problem, because patients’ medication histories may be lost in the process. The greatest example of this may be the exclusion of Walgreen Co. from the Express Scripts network in 2012. When patients are forced to switch pharmacies because of network modifications, a patient’s history and continuity of care gets lost in the process.
Although mail-order pharmacies benefit patients who are unable to easily obtain prescriptions from a traditional brick-and-mortar pharmacy (eg, disabled, rural populations), or who are taking medications for chronic diseases, their use also poses risks to continuity of care. Problems arise when patients visit their physicians and receive medications for acute issues (eg, antibiotics). Because waiting for a mail order of these medications is not feasible, patients will receive these medications from a local pharmacy that does not have access to the patient’s full medication regimen. For patients seeing multiple physicians, this can pose additional risks.
In an effort to win new patients, many pharmacy chains offer $15, $20, or even $25 for transferring a prescription from another pharmacy. This gimmick has been used by countless retail establishments in the past years; for the sake of business and money, patient care is being compromised. Although retailers hoped that patients would transfer all of their business to their pharmacy, the truth is that patients often transferred only one prescription to obtain the gift card, thus exposing themselves to potential medication errors.
There are times when patients will inevitably need to use a different retail pharmacy for filling a prescription; I have even been forced to use a different pharmacy while traveling. However, when possible, pharmacists should not only tell patients to use one pharmacy, but discern the underlying reasons for why patients are pharmacy hopping. With this knowledge, pharmacists can better counsel patients, and provide appropriate cautions. At the very least, pharmacists can instruct patients to inform the staff at the pharmacies they use of all medications that they are taking, regardless of where they were obtained. For more information about the perils of switching pharmacies, see “A Change in Pharmacy Is a Transition of Care."