When people buy drugs from Walmart, the Internet, & a pharmacy, harm can result

In last week’s blog I wrote about the problems that hospital staff often has in getting an accurate list of medications from patients when they come to the emergency room or are admitted. It’s critically important for doctors to know what you’ve been taking in order to properly perform a complete clinical assessment. Much the same is true when you go to the pharmacy to have prescriptions filled. With an accurate list, your pharmacist might be able to help you head off an adverse drug reaction or error that would require you to go to the hospital in the first place.

You may have heard from your doctor or pharmacist that it’s important to fill all your prescriptions at the same pharmacy so they maintain an accurate list for you. That would be nice, but in truth, with our fragmented healthcare system, it doesn’t always work that way. Insurance companies want to keep costs down for those who independently purchase insurance, or for employees and family members covered through work. They operate a pharmacy benefits management (PBM) firm or contract with one, which utilizes a mail-service pharmacy. These operations in turn encourage you to buy all long-term medicines through the mail. The insurance company provides incentives for that, often by allowing you to buy a 3-month supply of medicine from the mail-service pharmacy for the same co-pay as a 1-month supply from your community pharmacy. Still you will need to get prescriptions for short-term use from your community pharmacy. This includes antibiotics, pain medicine, and many other medicines used to treat a short-term illness or injury. (Read more here)

No matter where you get your medications, most often, a pharmacist checks that your doctor has prescribed a safe dose of the medicine and that it can be taken with your other medicines. Also, for payment, if you have a prescription plan and use it, your drugs must go through the plan’s computers, which will normally match what you’re getting with what’s on your record and alert pharmacists to potential problems. But if for some reason the medication you get at a community pharmacy isn’t covered, or you pay with cash, the mail-service pharmacist may know some of the medicines you take, while your community pharmacist knows of others, and none of them may know all the medicines you take. Therefore, they might not pick up a serious problem with how your medicines react together in your body.

Many consumer advocates suggest shopping around or buying your medicines over the Internet to get the lowest price. Some large pharmacy chains have begun to offer a 1-month supply of certain generic medicines for just $4 or even 3 months’ worth for $10, which is attractive. As expected, this encourages you to purchase whatever medicines you can that way. But since there is no insurance company reimbursement for this, the normal computer checking process will not occur if the prescription is not sent to the PBM. (See related story here.) So that’s another way that a complete record of your medications could fail to reach pharmacy computers.

Ideally, I agree that you should fill all of your prescriptions at the same pharmacy. But in real life, this may not be possible or even something you choose to do if lower-cost medicines are available at different pharmacies. Still, you can take the steps listed below to reduce the risk of problems.

Just as it’s important to have complete medication information if you need to be hospitalized, you also need to be sure your pharmacists have a current list of all your medicines, including herbals, vitamins, over-the-counter medicines, and prescription medicines. Some pharmacists might offer to keep note of certain medicines that are not purchased at that store. Otherwise, you should keep a current list and share that with your pharmacists each time you send prescriptions to be filled, whether to a mail service pharmacy or local community pharmacy.

There’s also a glaring safety concern that still exists. Most computer alerts fire so frequently and rapidly during pharmacist prescription order entry that they are sometimes bypassed or assumed to be unimportant when they shouldn’t be without further research. Although certainly not the norm, sometimes important warnings are inappropriately overridden. If you have computer access, it’s always best to use one of the free programs on the Internet that you can use to check whether your medicines will cause problems when they react together in your body (bad reactions are called serious drug interactions). For example, in partnership with MediGuard, there is a program you can access from our website that allows you to list what you are taking, check for possible drug interactions and learn whether something that’s potentially serious may have been missed. You can also use the service to maintain your medication list and receive a monthly form for updates that you can print out. The service also allows you to sign up for free alerts when new information is released by FDA or others that affects your medications. Of course information from these programs should not cause you to stop taking your medicine until you have sought professional advice.

For more on ISMP’s consumer website, go www.consumermedsafety.org.