Courtesy of an article in The Tennessean, we just learned that WalMart has expanded $4 discount generic drug program to offer some of those same drugs for $10 for a 90-day supply. A list of the prescription drugs covered by the program can be found here. In addition, Walmart will offer certain prescription drugs for women for $9 for a 30-day supply, such as the osteoporosis drug Fosamax and the breast cancer drug Tamoxifen. The $4 program also covers certain Over-the-Counter drugs.

WalMart isn’t the only chain store offering discount prescriptions on generics. Other stores with low-cost ($4, $5, etc) generic programs include (click the link on each store’s name to go to their discount program’s page):

• Target ($4 for 30-day supply)
• Kroger (More than 300 generics for $4)
• Walgreens ($12.99 for 90-day supply of 300 generics)
• KMart ($15 for 90-day supply on select generics)
• Randalls ($4 for select generics)
• H-E-B (500 generics for $5, 90-day supply for $9.99, 500 brand names for $50)
• RxOutreach is a program run by Express Scripts that offers 90-day supplies of many generics for $20-$40

One thing to keep in mind about all of these programs is that the numbers of generic drugs supposedly covered can seem much higher than it really is – for instance, one drug at different dosages might be listed 4 or 5 times — one for the, say, 10 mg pill, and another for the 20 mg, 30 mg, 40 mg etc. That would be counted as 4 drugs when it’s really one.

Also, some of the drugs on these discount program lists are drugs that are very rarely prescribed anymore. The stores have an incentive to inflate the “number” of drugs that they offer discounts on, and they do this by listing different dosages as separate drugs, and by including drugs that no one really uses any more. It doesn’t affect the usefulness of the discount if you can take advantage of it, but it’s a bit deceptive as it makes the program seem larger than it is.

In an article in the Houston Chronicle, Paul Beahm, Wal-Mart’s senior vice president of general merchandise for pharmacy, said:

“This is not a loss leader for us. We’re in business to make money, but we also know health care is one of the top three issues consumers think about. We don’t want to move costs around. We want to eliminate costs from the health care system. That fits with our everyday-low-price philosophy.”

This is probably not very reassuring to WalMart’s employees, less than half of whom had health insurance (43%) through WalMart in January 2006. (See here for that statistic. If any readers know of more recent stats, please post in the comments). If WalMart was serious about “eliminating costs from the health care system,” they’d make their health insurance more affordable and available to their own workers.

Also, WalMart’s claim that this is not a loss-leader (a product sold at or below cost to bring people into the store) is a bit disingenous, given that, according to the article mentioned above in The Tennessean:

[Tennesse has a] state law that bars Wal-Mart from charging below costs for medications and generic versions of drugs. Wal-Mart had been selling some of the $4 drugs here [Tennesse] instead for $9 to comply with state law.”

This means that there are drugs on the $4 list that WalMart is selling below cost. And it’s safe to say it’s not doing so to be charitable. There’s a reason that the pharmacy is usually at the back of the store in stores like WalMart — they know that most consumers will probably buy something else while there to pick up a prescription.

These discount programs can save consumers money, particularly those without insurance, and can encourage people to use generics. But they’re not a substitute for ensuring that people actually have health care coverage. What good is a $4 prescription if you can’t afford to go see a doctor? And what comfort is a $4 prescription to the millions of employees of WalMart and the other chains with discount programs who don’t have insurance? Finally, these discount programs put yet more pressure on small independent pharmacies, many of whom are struggling to stay afloat.

The Bottom Line? Use these programs if they will save you money, but still shop around, and be skeptical. And consider whether the store that’s offering the discount is doing more harm than good, on balance. You might pay a bit more at your local independent pharmacy ((but you might not – you can always see if your local independent pharmacist can match the Chain’s discount price or come close) But often those independents offer more personalized service, and by shopping there, you’ll be keeping your money in your community.

To learn more about some of WalMart’s questionable practices and policies, visit walmartwatch.com and Wake Up WalMart

The Southern supermarket chain Publix announced today that it will be offering seven common prescription antibiotics for free in its stores, located in Flora, George, South Carolina, Alabama and Tennessee. The move was reported in an AP story and in the Palm Beach Post.

The move follows on the heels of similar moves by other retailers, to offer selected generic drugs at low cost. Last year, for instance, Wal-Mart annoucned that it would offer a list of certain generic drugs at $4 per prescription.

What’s wrong with offering consumers free drugs? After all, many people, particularly people without insurance, have a hard time paying for prescription drugs. So free drugs will help them, won’t they?

It is true that free or discounted prescriptions can help patients, particularly the uninsured and low-income. But there is something peculiar and potentially disturbing about Publix’s move: The selection of antibiotics as the drugs to be offered for free.

Antibiotics are typically used for short periods of time to treat acute infections. Unfortunately, antibiotics are also massively overprescribed, which leads to the increase in infections which are resistant to common antibiotics. (See this June 2007 Denver Post article for more on the dangers of that resistance) The Palm Beach Post raised this concern in its article on the announcement:

Some public health officials have raised concerns about increasing use of some antibiotics because their overuse causes them to become less effective as the bacteria they target develop immunity.

The Publix initiative might contribute to that if doctors were to respond by increasing the number of prescriptions they write for the particular antibiotics the company is offering for free, said Lisa McGiffert, a health policy analyst for the Consumers Union, publisher of Consumer Reports, which has raised some concerns about antibiotic resistance

Will the fact that antibiotics are available for free at Publix cause doctors to prescribe more of them? Perhaps not. But there is still widespread inappropriate prescribing of antibiotics by physicians and nurse practitioners, often prodded by patient demands.

Another factor contributing to antibiotic resistance is patients not finishing the antibiotics they’ve been prescribed. It is still all too common for patients to stop taking their antibiotics when they begin to feel better. This allows bacteria to develop resistance to that particular antibiotic. It is a well-established principle of both economics and psychology that people’s perception of the value of a good relates to how much they paid for it — Thus, a patient who had to pay for their antibiotics is perhaps more likely to actually finish taking them, on the notion that “I paid for these pills, I don’t want to have wasted that money.”

The antibiotics being offered for free by Publix are all generics, and are not expensive compared to other prescription drugs. On drugstore.com, for instance, the cost of an illustrative prescrpition of 6 of the 7 antibiotics (oddly, Penicillin could not be found) covered by the program was:

amoxicillin: 30 capsules, 250mg $7.99
cephalexin: 30 capsules, 250mg: $8.99
erythromycin: 40 tablets, 250 mg: $9.91
ampicillin: 30 capsules, 250mg: $7.99
sulfamethoxazole-trimethoprim: 30 tablets, 400-80mg: $11.99
ciprofloxacin HCl: 30 tablets, 250mg: $113.65

The only one that was more than $12 was Cipro, which became famous several years ago during the Anthrax scare. $113.65 certainly isn’t cheap, but other forms of Cipro that patients frequently use are cheaper – for example, drugstore.com lists Cipro eye drops (0.3% Solution 2.5ml Bottle) at $15.99.

Since antibiotics are typically taken for a short period, this amounts to a very modest one-time savings. This underscores that this is mainly a marketing move, something which Publix more or less admitted in the Palm Beach Post story:

“No one else is doing this,” Publix spokeswoman Anne Hendricks said. “A couple of competitors offer low-cost. We have never been about that. We are always looking for ways to differentiate ourselves from the competition.”

The Lakeland-based company has 907 stores. In addition to Florida, Publix operates groceries in Georgia, South Carolina, Alabama and Tennessee.

With health care costs one of the biggest challenges facing many Americans, Crist said that the private sector’s involvement in the solution was “a great trend.”

Jenkins acknowledged that increasing pharmacy sales was a part of the company’s motivation but said the company also wanted to contribute to that trend.

“Frankly, we’re interested in building our pharmacy business,” Jenkins said. “But moreover, we want to help the citizens of our state have affordable health care, and we thought this was just a good start in doing that.”

The one-time savings this program represents does nothing to address the more serious problem of patients not having insurance or not being able to afford medications that they must (or should) take on an ongoing basis, such as medications for high blood pressure, diabetes, and other chronic conditions. The real cost obstacles in prescription drugs are not in generic antibiotics.

Just as the discount programs at WalMart and other chains did, it is likely that these free antibiotics will function as a “loss leader,” drawing people into Publix, where they will inevitably purchase other non-pharmacy items. Whether it will do anything of significance for people without drug coverage is much less certain.

One option for people without insurance is a Patient Assistance Program that offers steeply discounted generic drugs — www.Rxoutreach.org