A business idea for Wal Mart

Bruce Jaspen in the NY Times Prescriptions Blog writes about Wal Mart’s supposed interest in expanding its retail health care offerings.

This got me to thinking about what mail order pharmacy providers do to local retail pharmacies.

Several years ago, Duke changed its health insurance plans in a way that greatly incentivized employees to use a mail order pharmacy. For example, I take a prescription for which I could get one month’s supply from the local pharmacy for $140, or three months worth via mail order for $100. A big difference that changed my behavior. It also triggered a rant from my wife.

The source of her rant was a mixture of lessened options, mixed with a more subtle worry. The mom and pop pharmacy (they rent space in the back of a hardware store) that fills prescriptions for my mother in law who also lives in Durham was nearly put out of business (according to them) when Duke shifted to the mail order pharmacy. The pharmacist there has called my wife on numerous occasions saying that he was worried that my mother in law was differentially taking her medicine (they weren’t running out at the same time). On several occasions, they have delivered medicines to my mother in law at no charge. This is a valuable service.

After the mail order pharmacy was instituted, there was an outcry from Duke employees and a new option was provided just 6 weeks into a benefit year: you can have prescriptions filled in the outpatient pharmacy at Duke Hospital for the same price as the mail order pharmacy.* We tried this. Whenever I went there, I felt as though I must be part of a psychological experiment designed to ascertain my breaking point, or I thought the candid camera guy would hop out at any time to capture Duke Professor acting like a fool.

Herein lies the business proposition: Wal Mart (or CVS, or Walgreens or anyone) should bid for the Duke pharmaceutical benefit contract. I bet they could do it as cheap as the mail order pharmacy, and they would provide better customer service than the Duke hospital pharmacies. This, of course, wouldn’t help the mom and pop pharmacy but would keep the commerce local.

*Note: Further proof that Americans say we want to moderate health care costs but are roughly opposed to anything that might actually do so.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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