Hometown Pharmacies Hurt by Mail Order

Years ago, the local neighborhood drugstore was a gathering place for people in the community. The pharmacist frequently offered homespun advice and compounded concoctions as well as dispensing prescriptions.
In our community there was a pharmacy that was known far and wide for its incredible soda fountain and the amazing milkshakes made there. The pharmacist knew most of his customers by first name and had known their parents and grandparents.
On one wall was a bulletin board with photographs of babies. When pregnant women were overdue and anxious to give birth, the pharmacist would mix up a special drink for them that would often have the effect of jump-starting their labor.
Such hometown pharmacies are slowly fading away. They are being replaced with huge national chains or even mail-order companies. Instead of consulting a pharmacist face-to-face, patients wait for the mailman to leave a package.
Employers are increasingly requiring patients to purchase their prescriptions by mail. Even if it isn’t absolutely mandatory, financial incentives may make it hard to resist mail-order medicines. With prescription drug prices continuing their upward spiral, insurance companies are pushing patients to buy the lowest cost generic drugs possible, often through an online or direct mail vendor.
There are downsides to this lower-cost approach. For one thing, there is no face-to-face contact with a pharmacist. There may be an 800 number for questions, but the patient will be speaking with the disembodied voice of a stranger. Trying to get detailed instructions about how to use an asthma inhaler, for example, could be tough over the phone.
Older people may find it especially challenging to navigate a phone tree or request a prescription online. Then there is the problem of drug interactions. Unless the patient buys all her drugs from the same place, there may not be a warning about incompatible medicines.
Finally, questions have been raised about the delivery process itself. Many medicines are supposed to be kept within a narrow temperature range, but delivery vehicles are rarely climate controlled.
During the summer, temperatures inside a mail truck or UPS van can get mighty warm. But that’s nothing compared to the temperature inside a black mailbox on a hot afternoon. A sensitive chemical compound may deteriorate much faster if it sits for hours waiting for the patient to rescue it.
A lot of people are procrastinators and wait till the last minute to order a refill. After all, a three-month prescription, typical for mail order, can be pricey. Running out of pills can be dangerous for people with serious conditions like diabetes or heart disease.
And what will people do if they suddenly get sick and need a prescription in a hurry? Waiting two or three days for an antibiotic or a migraine medicine to come in the mail doesn’t make sense. If local pharmacies can no longer compete with the big players, though, some communities may be left without a hometown drugstore. That would be a tragic loss.
We may not be able to go back to the days of soda fountains and friendly familiar pharmacists. But we should take care that convenience and economy do not jeopardize the community’s health.