Nobody knows more about medications than pharmacists do—not doctors, not nurses, not anyone. As Ronald Jordan, dean of Chapman University's School of Pharmacy, in Orange, California, puts it, "Those with the right to prescribe know far less about drug therapies than pharmacists, and consumers need to make use of that knowledge." Here, find out why generics cost less, how far in advance you should call for a refill, and more.
- Chain-store pharmacists have quotas to meet. Fifteen minutes: that's how long pharmacists at chains like CVS, Walgreen's, and Rite Aid have to fill a prescription once it's called in. One CVS pharmacist, who wants to remain anonymous, even compares the process to McDonald's. "Sometimes it's [filling] 25 medications at once, bang, bang, bang," he says. "If we take longer than we're supposed to, we get written up and have to meet with district managers. It can even affect bonuses. It's a lot of pressure."
- Mornings are the best time to fill prescriptions. Like doctors, pharmacists—especially those at mom-and-pop shops, who don't have quotas to meet—are less likely to make you wait first thing in the morning. As Martin Ochalek, a pharmacist in Miami, puts it, "Once the doctor calls start coming, it slows down everything." The exception? Independent pharmacies. "Any time of day is a good time to call in a prescription since they need the business," says Joey Jimenez, a former pharmacy tech who specializes in compound (or "made-from-scratch") drugs at Total Pharmacy Supply. Another timesaving tip: call before you go to confirm your prescription is ready for pick up.
- If it takes longer than 15 minutes, be patient. Getting the wrong prescription can have serious consequences, which is why it pays to be patient. "Time pressures can contribute to medication errors," says Sally Rafie, PharmD, a medication safety specialist at the UC San Diego Health System. "The pharmacist does far more than count pills and place them into a bottle. Pharmacists are reviewing allergies, drug interactions, dosing, and much more to be sure you get a medication that will be safe and effective for you."
- Doctors' handwriting really is that bad… So bad, in fact, that it can lead to mistakes—which is why pharmacists need to be extra vigilant when filling prescriptions. "It's amazing how horrible their writing is sometimes," says Ochalek, who recalls a time when he received a child's prescription for amoxicillin that appeared to be three to four times the proper dosage. While a call to the doctor can clear up any issues, it's an extra step—one that usually ends with the customer waiting longer. Jimenez is a proponent of electronic scripts. "But not everyone has switched to the system yet because it's an additional cost," he says.
- Pharmacists don't set prices. There's no denying that medications are expensive, even with health insurance. But unlike typical retail stores that choose how much to mark up products, pharmacies have no say in what they charge. "Customers are not aware of what's going on with the pricing of drugs these days," says Jack Porter, a pharmacist in Beverly Hills. "A cream that used to cost $10 can cost $150 all of a sudden, and I would love for people to be aware of that."
- You can't—and shouldn't—always get a generic. First, a primer on generics: According to the FDA, they are "identical to a brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use." So why do they cost less? Once a brand-name drug hits the market, it holds its patent for around 20 years, and no other pharmaceutical company can make or sell it until the patent expires. But once it does, companies are free to manufacture it—without the cost of building it from scratch. Keep in mind that not every drug has a generic, and that even when one does exist, a pharmacist may not always recommend it. Says Porter: "I don't substitute certain medications that treat seizures because the generic dissolves at a different rate," which is an occasional difference between generic and brand name drugs. "On the generic, there's a chance they could still have a seizure. I wouldn't take the chance."
- Don't wait until you're out of medicine to order refills. As we all know, doctors are busy people—and they're the ones who hold the key to you getting a refill for your medication. Which is why it's important to give your pharmacist a few days to get ahold of them. "Doctors don't always call back promptly, and it's not automatic that you can get a refill the same day," Porter says. A good rule of thumb: let the pharmacist know when you have five or six pills left. "This is especially true for maintenance drugs like blood pressure meds. Missing a day or waiting extensive periods of time between dosages can have harmful effects," adds Jimenez.
- Don't use the pharmacy checkout if you're not picking up a prescription. We've all been there before: The checkout line snakes into the aisles and all you want to buy are a few toiletries. But resist the temptation to pay at the pharmacy. "While pharmacists are happy to help, it distracts them from the important work they're doing, which can lead to unintentional errors," Rafie says. "And don't ask the pharmacist where to find the batteries, diapers, or restrooms!"
- Build a relationship with your pharmacist. Build a relationship with your pharmacist for personalized care. You wouldn't switch doctors each month—and the same approach should be applied to your pharmacist. "Like any healthcare provider, patients are better served if they develop a relationship with their pharmacist," says Jordan. "They're willing to spend extra time with you, and it's always helpful to know the person on the other end of the phone line." In addition to getting more personalized attention, it's also more practical to stick with one place. "It's a lot of extra work for the pharmacy to keep transferring the prescription," says Rafie, adding, "There's no way each pharmacy can have all the information they need on file to make sure a medication is safe for you."
- Know the meaning of "as directed." You may have noticed a doctor write "as directed" on a prescription. This indicates to the pharmacist that the doctor has already explained to the patient how to use the medication. While some medicines' instructions are obvious, others can be taken many different ways. "I'll get people who come in with a prescription and ask, 'why am I taking this?' " Porter says. "It's important to look at the prescription when you get it, and leave the office with some understanding of what it is—especially if it says 'as directed.' "
- Ask the right questions… …though a good pharmacist will automatically provide many of the answers, including when to take the medication, whether or not to take it with food, what the side effects are, and if it needs to be refrigerated. "A patient needs to walk out of a pharmacy confident that they know what to do," Porter says. "If they're not, then they need to ask more questions." In the end, the customer is the one who will suffer the consequences. According to Jordan, "If people stop taking medication before they should or don't use them as prescribed, they may end up in the emergency room or having to take additional, higher-cost drugs as a result." And while allergies are typically included in your medical file, speak up if the pharmacist doesn't ask (though he or she should). As Porter puts it, "The ultimate responsibility is on the patient to make the pharmacist aware."
- Don't buy medicine online. Just because some prescription drugs are a click away doesn't mean you should give into the convenience—even if they cost a little less. (The exception: something you have been taken regularly without any issues, such as birth control pills.) "The financial advantage is there, but the biggest problem is people end up using medications incorrectly or not recognizing side effects," Jordan says. "You're so much better off going through a pharmacist, where you can get advice face-to-face."