10 Things Your Drugstore Won’t Say

6. “We’re a magnet for drug dealers.”

Mark Riley can always tell what drug is hot on the black market: He just looks at drugstore break-ins and robberies. “Really, what determines pharmacy theft is, ‘What is the drug of choice now?’” says Riley, a pharmacist and the executive vice president of the Arkansas Pharmacists Association. When pharmacies enjoy a peaceful spell, he says, it’s a sign that dealers are trafficking in methamphetamine and crack. But all too often, crooks are after heavy-duty prescription painkillers like hydrocodone and oxycodone (often sold under the brand name OxyContin).

Last year, pharmacies reported 668 drug thefts (often of painkillers, experts say), 8% more than in 2011, according to RxPatrol, a crime-tracking system run by Purdue Pharma, the maker of OxyContin. And a growing proportion (64%) of the pharmacy thefts were armed robberies, while burglaries (simple breaking and entering) remained flat. The statistics may reveal a disturbing pattern, says Luis Bauza, RxPatrol’s director of investigations: Prescription drug thieves are carrying weapons and using more force to steal. RxPatrol profiles the typical theft in order to warn pharmacies what to watch out for. Among the stats: 75% of hits are at chain drugstores, and offenders usually strike between 10 a.m. and 2 p.m.

RxPatrol recommends strategies for pharmacies to avoid becoming a victim, by installing security cameras and signs alerting people to the surveillance. (CVS, for one, works with law enforcement to ensure that its stores are safe for customers to shop and fill prescriptions, though the chain would not disclose specific security measures “because we do not want to undermine them,” a spokesman says.)
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7. “Want a better deal? Go over your boss’s head.”

In 40 years as a pharmacist, Richard Hartig says he’d never seen such a mass exodus of patients. A few years ago, Medicare Part D excluded his 16-store Midwestern pharmacy chain, Hartig Drug, from its list of “preferred pharmacies.” The change meant that his customers 65 and older would have to pay $7 per prescription at his store, compared with $2 at Wal-Mart, which had a deal with the insurance plan. Since then, every January, Hartig has watched helplessly as thousands of customers leave, forced to go to, or order by mail from, a pharmacy within their plan’s network. “When it comes down to who’s going to sell it the cheapest, we’re never going to win,” he says.

As employer health plans and insurers strive to cut costs, they are increasingly restricting what drugs they’ll pay for and where consumers can buy them. A fifth of employers have a preferred pharmacy network, where they reimburse a higher share of drug costs because they’ve negotiated lower prices, and 11% have a limited pharmacy network and won’t pay anything for prescriptions filled elsewhere, according to the Pharmacy Benefit Management Institute. On top of that, a third of larger employers have mandatory prescription mail-order services, which deliver 90 days’ worth of meds at a time at a cheaper rate.

Now pharmacies are trying to fight back by going over the boss’s head and offering deals on drugs that undercut insurers’ prices: 43% of chain pharmacies sold some generic drugs for $4 or less per prescription (to those paying out of pocket, instead of with insurance) in 2012, compared with 38% in 2011, and 66% offered 90-day refills, up from 58%. “Sometimes paying cash might be a better deal than going through your insurance,” says Adam Fein, president of health-care advisory firm Pembroke Consulting. He recommends that patients ask pharmacists for both prices to see which is the better deal.
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8. “We’ll make your medicine to order, but might mess it up.”

When drugs are in short supply, the Food and Drug Administration sometimes encourages pharmacies—big chains and independent drugstores alike—to mix up their own. When pharmacies sold out of flu treatment Tamiflu during the epidemic this winter, the FDA posted the drug’s recipe online, and drugstores quietly whipped up their own batches.

This practice, known as compounding, has become controversial in the wake of an incident last fall, in which a compounding pharmacy dispensed contaminated drugs that is linked to hundreds of people meningitis, killing 50. Most drugstores, including the ones that make their own Tamiflu, don’t do the type of “specialty compounding” performed at that facility, and some aren’t legally allowed to. But pharmacies in general worry that the scandal will cast a pall over a common and important part of their business. “The FDA has been skeptical of pharmacy compounding because of what happened, but they recognize it as an option,” says Coster, of the National Community Pharmacists Association.
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9. “Take two California rolls and call me in the morning.”

Consumers may usually get it over the sushi bar, but over-the-counter maki rolls are now available in more than 175 Walgreens and Duane Reade (also owned by Walgreens stores. Four locations, including two in New York and others in Chicago and Hollywood, feature a resident professional sushi chef. Makis like spicy tuna and California rolls average $5 to $10—though only stores with on-premises chefs sell raw fish and sashimi; other stores just offer cooked sushi.

Experts say the unconventional drugstore items are a way to attract more customers to the store now that drugs themselves are no longer a cash cow. And Walgreens says the sushi is another way the store can promote healthy choices: “Sushi is a much better health food than hamburgers,” Dr. Kang says. But some consumers think the sushi is more of a turnoff than an attraction: Iron Chef Masaharu Morimoto, for one, has questioned drugstore sushi’s quality and criticized its refrigerated texture. Walgreens says its sashimi-grade sushi is prepared daily with the highest food safety standards, and cooked sushi is delivered fresh six days a week.
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10. “You say cold symptoms? We say possible meth addict.”

Jim Acquisto still remembers the humongous stash of cold medicine—243,000 doses of pseudoephedrine—that his police force discovered in a Kentucky methamphetamine lab a few years ago. But thanks to federal law and new technology allowing pharmacies to block excessive purchases of decongestant, the ingredient needed to cook methamphetamine, the stuffy-nose treatments are now much harder to buy. “You really shouldn’t be allowed to have that much cold medicine without someone saying, ‘Hey, this is not right,’” says Acquisto, now vice president of government affairs for Appriss, the technology company behind NPLEx (short for National Precursor Log Exchange), a system for tracking drugstore sales of pseudoephedrine and ephedrine. The register-based system allows pharmacists to monitor purchases across state lines in real time—and alerts them when a sale would be illegal. Half the states now require pharmacies to use the system, which enforces a 2006 law that limits purchases of about 150 brand-name cold and allergy medicines, including Sudafed and Claritin D, to 3.6 grams per day and 9 grams per month. (A large box of Sudafed with 20 pills is 2.4 grams.)

Other states restrict the purchases further, requiring a prescription or an in-state ID. Experts say consumers can still get all the cold remedies they need, corresponding to the doses recommended on the boxes —at the pharmacy counter. “We recognize there’s inconvenience in it—pharmacists don’t like to keep it behind there either—but at the end of the day, the reduction of these meth labs is worth the inconvenience,” Riley, of the Arkansas Pharmacists Association, says. Still, in the other half of states, pharmacies just record the purchases on paper logs (except in a handful of chains like CVS that have installed NPLEx nationally).

By Jen Wieczner | MarketWatch

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