Ever wonder why we have so many pharmacies around town? It seems as if there's a new one on every other street corner these days. Some of them seem to have found all sorts of ways of making money from the unwary consumer.
Just last week I went in to my local pharmacy with a prescription for a year's supply of a low dose thyroid medication that I've been taking since I was in high school. As usual, I asked my doctor for a prescription for one year's worth of pills. After all, I'm healthy, and don't need to visit her more than once a year to monitor this condition. It saves everyone time and money, right?
I've been doing this for several years now, stocking up with a yearly trip to the pharmacy instead of costing our health system repeat visits to the doctor for smaller prescriptions, and occupying her time which could be spent seeing patients actually in need of her attention.
This year was a different story when I decided to try a new drug store. I cordially handed over my prescription for a one-year supply of pills. Yes, I anticipated the usual sales pitch where they try to get you to buy your pills in one month increments (thus charging you 12 "dispensing fees" instead of 1). So I was surprised when the pharmacist, a nice lady with a firm voice, had a new line: "No," she said, "I'm sorry, but the maximum I can give you is a three-month supply."
She made this sound like a law, like health policy written in stone. We debated this a bit and went back and forth. I even pointed out I was given a one year's supply last year at a competing pharmacy. Finally, she went away and came back with a final verdict: "No, we can only give you a three month's supply -- that is all Pharmacare allows."
She assured me I could come back in three months for the next set of pills. Reluctantly, I agreed and paid my bill and left the store. It was only when I got home that I discovered I had paid the same dispensing fee for a three-month supply as I would have for a one-year supply. Turns out, it doesn't matter if you get 10, 100 or 365 pills -- the pharmacy charges the same fee for each visit.
In other words, pharmacies have every reason to encourage you to purchase a few pills at a time and to refill frequently.
Dispensing fees are not created equally either. The dispensing fee cost varies widely from pharmacy to pharmacy -- and all you have to do is phone and ask. I did a random sample in my neighbourhood and found that the Shoppers Drug Mart charges the highest dispensing fee at $13; Rexall was close at $11.99; Loblaw was $10.10, and even Walmart charged $9.97. Costco only charge $4.49 for dispensing..
Incidentally, I called Manitoba Health and asked if Pharmacare puts any restrictions on how many pills a drug store can dispense. Apparently there is a 100 day limit -- but it applies only if the payer (those paying for the medication) is Pharmacare, and some insurance companies have a similar limit.
If you are the sole payer for your prescription drugs and you aren't expecting to be reimbursed for your drug purchase, you can fill a 1,000 tablet prescription at one time -- there's no limit. One has to wonder why insurers are sitting back and encouraging these extra dispensing charges to be billed. Why not allow those on long-term medications to have one time annual fill ups? (Of course, if you have a condition that requires regular monitoring or if the drugs are new for you, regular consultations with the doctor and pharmacist are a good thing).
It looks like we need to become better consumers when buying our prescription drugs.
The bottom line: Call around and find out which pharmacy in your neighbourhood has the cheapest dispensing fee. And if they push you to take a supply which would mean having to come back to them for repeated refills, simply say "no thanks."
Who needs extra trips to the doctor or the drugstore? Every time you pick up more pills it helps fill the cash register at the pharmacy and empties your pocket. That pharmacy fee which will be added on every time you come back might be better spent elsewhere. After all, there are plenty of good new movies out there.
Noralou Roos is Professor of the Faculty of Medicine at the University of Manitoba and the co-founder of EvidenceNetwork.ca.