The Barton Pharmacy has been sold to Kinney Drugs, which will operate it as a “remote” pharmacy. No actual pharmacist will be on site. Instead, a pharmaceutical technician will fill prescriptions via a computer link with a pharmacist.
And if the customer wants to talk directly to the pharmacist?
There will be an 800 number.
Possibly efficient, perhaps economical, but undoubtedly impersonal.
That’s the modern world, though. The ATM, being not a person at all, is more impersonal than the bank teller, who is. The order-taker/cashier behind the counter at a fast food restaurant is a person, but the customer’s connection with her is more impersonal than one with a table-service waiter. The Internet is so impersonal that even when it is “social” (think Facebook), no actual personal contact takes place.
As it happens, it was the Internet — along with some other impersonal forces — that did in the Barton Pharmacy as an independent drug store. Many of these small stores survived competition from the big chains such as Rite-Aid (which bought out Lyndonville’s independent drug store a few months ago), Walgreen, and — yes — Kinney’s. Drug prices at the chains were sometimes lower. But the independents offered personal service and often filled prescriptions faster.
Now comes the order-online/get-your drugs delivered-at-home phenomenon. The drug manufacturers, the insurance companies, and the pharmacy benefit management firms that act as the “middlemen” between manufacturers and retailers are combining to suggest that customers cease bothering with any brick-and-mortar pharmacy at all. Just go online or call a toll-free number, place your order and Presto! Your prescriptions will be delivered to your door.
Buzzy Roy, the owner of Brown’s Drug Store up in Derby Line, would argue with the word “suggest” in the previous paragraph.
“They don’t suggest,” he said. “They force. They tell (customers) they have to order that way or their drugs won’t get paid for.”
Roy (yes, that Buzzy Roy: the Derby Line village trustee who’s been taunting the Border Patrol by walking across the border from Stanstead, Que.) says his store is doing well because “we offer real personal service,” and the store has built up a loyal customer base over the years. But he acknowledged that he has lost business to the online/mail-order providers.
Amy Braun, the energetic young woman who’s owned the Barton Pharmacy for a decade said she “lost 6,300 prescriptions last year and 4,800 the year before,” largely because so many customers switched to mail-order delivery.
In many cases, she said, the pharmacy benefit manager firm and the insurance companies made it “significantly cheaper (for customers) to mail order” rather than get their prescriptions filled at a local store. For instance, she said, some customers were told they could save money by getting a 90-day refill rather than refilling monthly, because they would only be charged for one “co-pay,” the customer’s share of the total cost.
“I can’t blame people,” Braun said.
Whether or not actual force is used, there is little doubt that the centralized, corporate, pharmaceutical establishment (manufacturers, insurers, pharmacy benefit managers) is providing powerful incentives for customers to forsake their local drug stores. For instance, United Health Care, the AARP-affiliated health insurer that provides many Vermonters with their “Medi-gap” policies, recently told its customers that it had “negotiated with some of our network pharmacies…to give members even lower costs on many common prescription drugs.” But to get these lower prices, customers would have to go to the company’s “Pharmacy Saver” web site.
The “negotiated with” part of that announcement is key here. At one level or another, most drug prices are negotiated. A big insurance company like United Health Care has market power. So does a big chain like Rite-Aid or Kinney’s. A small independent drug store does not. It often has to pay the price set by the insurance company or the PBM.
“The main challenge is from the pharmacy benefit managers,” said John Norton, the associate director of public relations for the National Community Pharmacists Association, based in Virginia. “They administer the drug plans for employers. They’re very large and powerful, so they dictate the terms.”
Norton, to be sure, is not an impartial observer. But concern about the power of pharmacy benefit managers is not limited to the independent pharmacy world. Earlier this year, five consumer groups asked the Federal Trade Commission to break up the $27 billion merger between the CVS drug store chain and Caremark, one of the big pharmacy benefit manager companies. When the middleman and the retailer are all the same company, the groups argued, the consumer gets hurt. And in its most recent Form 10-K filing with the Securities and Exchange Commission, CVS-Caremark acknowledged that several state attorneys general were looking into possible anti-competitive practices by the farm.
Another pharmacy benefit manager, Medco Health Solutions, was once part of Merck & Co., the big pharmaceutical manufacturer. Medco is now on its own, but that does not necessarily mean it is completely independent of Merck. The separation of the two firms was a spinoff of Medco stock to Shareholders of Merck, according to a New York Times story published on Aug. 20, 2003.
Nobody seems to have compiled a history of Vermont drug stores, so it’s impossible to determine how many independent pharmacies have closed over the years. Norton said that by his organization’s count, 25 independent drug stores are still in business in the state, along with 95 chain outlets.
There is obviously nothing unusual about independent, locally owned businesses being supplanted by consolidated chains or high-tech competition. The locally owned clothing store, grocery and record shop have been largely replaced by nationwide chain stores, or, as in the final example, by computer downloads.
By all indications, most people don’t mind. Like other Americans, Vermonters may say they prefer local and homegrown, but they also like the standardization and low prices of corporate chains. Mail-order prescription drugs could well face the same reaction. Norton said that drugs sent through the mail are sometimes lost, sent to the wrong house, or sent to the right house when no one is home to put temperature-sensitive medicine in the refrigerator.
“Then you have to run to the retail pharmacy down the street anyway,” he said, adding that “dealing face-to-face with the pharmacist” is the best way to avoid improper use of medicine.
But customers, especially the elderly who make up a disproportionate share of prescription drug users, no doubt appreciate not having to schlep to the drug store, especially on a snowy Vermont day. And almost everybody likes low prices. Why else put up with the ugliness of big box stores?
Another independent business getting harder to find is the diner or coffee shop, sometimes located in a drug store, which then becomes not just a place to get medicine and trinkets, but a community gathering-spot to pick up the local gossip.
Happily for Barton, Amy Braun plans to continue running the Step Back Café which has occupied about a quarter of her drug store, serving breakfast, lunch, snacks and coffee. In fact, her plan is to expand into a part of the building just vacated by a realtor and create a full-service restaurant open for dinner.
Here’s one Vermont town that is losing an independent pharmacy, but perhaps gaining a touch of night-life.
