Do you think pharmacists should be able to prescribe? Why or why not?

[PrePharmD]

Okay, so this was an interview question. I'm not going to say what my answer was because I want an unbiased opinion from those of you have might have a much better idea of what extra duties/responsibilities being able to prescribe entails. Really, any and all opinions are appreciated.

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[Sparda29]

Pharmacists can and should be able to prescribe. It makes things more affordable and definitely more convenient for the patient. Of course, there should be a physical examination of the patient prior to prescribing anything, I don't know how much that will affect the pharmacists who got into pharmacy because they didn't like the "icky" factor of medicine.

In fact, we just read an article in class about this.

 

[alenadoma]

Can't pharmacists prescribe in certain states??
Yes, I think they should be able to prescribe, especially for medications that do not require bloodwork/extensive physical examinations.

 

[UNMorBUST]

I agree with above posts. It would save patients money who dont need an extensive physical.

 

[tbs fan]

how does it actually save patients money?

 

[alenadoma]

how does it actually save patients money?

They wouldn't have to pay office visit copays.

 

[confettiflyer]

Under limited circumstances, yes. This is already the case with hospital pharmacists and only if the hospital has a protocol for it (usually big teaching hospitals/progressive hospitals). Also, collaborative practice agreements would allow pharmacists to prescribe in the case of disease mgmt or other otherwise stable pt's.

Now, in terms of straight prescribing, I completely disagree with the pharmacist's right to prescribe. We are not trained to diagnose the way physicians and other mid-levels (ie PA's, NP's) are, period. If there's no diagnosis, we should definitely not be permitted to act. Exception should be, IMO, certain drugs/topical agents/etc... that are fairly innocuous (i.e. a pharmacist at Wags wouldn't be starting a pt on warfarin).

Not only do laws have to cover the above, but it would require a change in billing procedures for insurance companies. As it stands right now, most pharmacists are paid a salary vs. a fee for services rendered. I know this is already happening in certain cases should a pharmacist do some sort of intervention, but it's not very widespread.

For example, let's say a pharmacist in your jurisdiction has a limited ability to prescribe HTN or antihyperlipidemics at your local retail pharmacy if a pt already has a script on file for a one month supply. Had the pt gone to his/her PCP to get this refill, or even the NP at the CCC next to the pharmacy, that HC professional would be able to third-party bill. So...would then the pharmacist work for free in that respect? They did offer a service, they should be paid for it.

Finally, liability insurance would have to be augmented since, by virtue of prescribing, the pharmacist assumes greater liability.

Lots of stuff to think about.

 

[confettiflyer]

They wouldn't have to pay office visit copays.

So the pharmacist works for free? See above post.

 

[WhiteSnows]

No.

 

[medicalCPA]

I do not think pharmacists should be able to prescribe. For me, it's more of a "segregation of duties" thing (accountants will know what I'm talking about). The pharmacy profession exists to ensure the safe and effective use of medications, and dispensing is a big part of that role. The same profession should not be prescribing medications. That's why the doctor can prescribe but (largely) cannot dispense.

However, I believe that pharmacists WILL be able to prescribe in the future. As the profession expands, those who elect to prescribe will be able to do so, but only after they undergo further training to prepare them for that function. Since it's the training in diagnosis that's lacking right now (according to physicians, NP's, and PA's), that training will be open to pharmacists in the future and voila, those who choose to will be able to prescribe. That's what I believe will happen.

 

[confettiflyer]

However, I believe that pharmacists WILL be able to prescribe in the future. As the profession expands, those who elect to prescribe will be able to do so, but only after they undergo further training to prepare them for that function. Since it's the training in diagnosis that's lacking (according to physicians, NP's, and PA's) right now, that training will be open to pharmacists in the future and voila, those who choose to will be able to prescribe. That's what I believe will happen.

I agree, the floodgates are slowly opening. There will be an argument that if a mid-level with only 2 years of school can prescribe, then so should someone with 4 years of school/4-yrs school + residency. I disagree with boiling this down to years in school, but autonomous prescribing for a PharmD w/ some sort of additional training just might become a reality within the next 5-10 years.

 

[Transformer]

The question is how long of a program will this "additional training" be to prescribe autonomously?

Will this be a creation of a new degree?


Pharmacy Prescribing Practitioner?


I seriously see the field of pharmacy headed towards precribing medication but not autonomously; at least not at first.

 

[Sparda29]

Well originally it all started with apothecary's where the prescribing and dispensing was done at the same place, but then they branched off.

But I mean for pain medication and antibiotics, I think a pharmacist has sufficient training to diagnose and prescribe.

 

[alenadoma]

Well originally it all started with apothecary's where the prescribing and dispensing was done at the same place, but then they branched off.

But I mean for pain medication and antibiotics, I think a pharmacist has sufficient training to diagnose and prescribe.

I agree!

 

[confettiflyer]

Well originally it all started with apothecary's where the prescribing and dispensing was done at the same place, but then they branched off.

But I mean for pain medication and antibiotics, I think a pharmacist has sufficient training to diagnose and prescribe.

though ideally you'll want to know what bug they have before giving abx. i just can't see the idea of a pharmacist ordering a rapid strep test or culture.


it almost becomes...if you're a pharmacist autonomously prescribing for minor ailments (outside of a hospital protocol type setting), what's the point of being a pharmacist if you're just a glorified NP/PA? CCC's already fill this niche.

Plus, insurance companies/public at large already don't want to pay for MD services unless they have to, so to say that a pharmacist has sufficient training in diagnosing/prescribing abx and pain meds is moot point if no one wants to pay for it (though I do agree with the statement).

(btw to clarify these comments are more about CCC prescribing vs. other types of "prescribing" such as interventions/dose changes).

 

[laimyours]

I agree, the floodgates are slowly opening. There will be an argument that if a mid-level with only 2 years of school can prescribe, then so should someone with 4 years of school/4-yrs school + residency. I disagree with boiling this down to years in school, but autonomous prescribing for a PharmD w/ some sort of additional training just might become a reality within the next 5-10 years.

I agree. I don't think the pharmacist at the retail chain should be prescribing. And, I don't think we should be prescribing antibiotics without knowing the bug. I also don't want to prescribe pain medication. Then all those pill seekers will bother you to prescribe them pain meds, and the excuse of I can't won't be valid anymore. I think that pharmacists that would closely with doctors and have additional training should be able to prescribe/adjust doses.

 

[confettiflyer]

I also don't want to prescribe pain medication. Then all those pill seekers will bother you to prescribe them pain meds, and the excuse of I can't won't be valid anymore.

Oh you hit this one right on the head. Pharmacists get harassed NOW to call the MD or advance them 1-2 tablets for their freakin' norco. Given the lack of respect and the predominant public view of the "strict dispensing/pill counting pharmacist"....I think if you give the RPh license to prescribe, suddenly he/she will become "pill counting pharmacist who holds the keys to the castle as well... let's harass away."

Because you know this pt is at their MD office with a halo over their head getting the script becomes the monster pt that shows up at your drop off window getting "filled at other pharmacy 2 days ago" TP denials who huffs and puffs about it.

Oh boy...that's just a pandora's box waiting to break open. Glad you brought this one up.

 

[FarscapeGirl]

What about drugs like birth control pills? I know it's been considered to allow pharmacists to prescribe birth control pills.

My feeling is it would be good to get more women protected against unwanted pregnancies, but it might also reduce the health care women get. Right now, women have to go to the doctor at least once a year to get a birth control prescription. They can then get their blood pressure checked, weight checked, etc. But if a pharmacist gives the women their prescription instead, this might reduce even more how often a woman sees a doctor or nurse practitioner.

 

[alenadoma]

Oh you hit this one right on the head. Pharmacists get harassed NOW to call the MD or advance them 1-2 tablets for their freakin' norco. Given the lack of respect and the predominant public view of the "strict dispensing/pill counting pharmacist"....I think if you give the RPh license to prescribe, suddenly he/she will become "pill counting pharmacist who holds the keys to the castle as well... let's harass away."

Because you know this pt is at their MD office with a halo over their head getting the script becomes the monster pt that shows up at your drop off window getting "filled at other pharmacy 2 days ago" TP denials who huffs and puffs about it.

Oh boy...that's just a pandora's box waiting to break open. Glad you brought this one up.

Oh no way should pharmacists be able to prescribe ANY controls. Who's to say that a druggie/drug dealer wouldn't go to a hundred different pharmacies, put on a good show, and get 100 prescriptions of hydrocodone written and filled!!

 

[confettiflyer]

Oh no way should pharmacists be able to prescribe ANY controls. Who's to say that a druggie/drug dealer wouldn't go to a hundred different pharmacies, put on a good show, and get 100 prescriptions of hydrocodone written and filled!!

i know right, haha...i've seen some pretty good shows.

this already happens with MD's....good times for doctor shopping! I remember they busted this MD out in the IE in CA for basically giving pt's oxycodone scripts after telling them to "fake some symptoms" or something and pay for the "office fee."

An undercover DEA agent came in as a pt and the MD told her, "I guess you know how the game works!" and handed her a script. ooooh, busted.

 

[Sparda29]

They could have labs in the pharmacy to run cultures.

 

[alenadoma]

They could have labs in the pharmacy to run cultures.

They could, but they'd also need someone to interpret the results, and who'd take the samples?

 

[mddr1day]

What about drugs like birth control pills? I know it's been considered to allow pharmacists to prescribe birth control pills.

My feeling is it would be good to get more women protected against unwanted pregnancies, but it might also reduce the health care women get. Right now, women have to go to the doctor at least once a year to get a birth control prescription. They can then get their blood pressure checked, weight checked, etc. But if a pharmacist gives the women their prescription instead, this might reduce even more how often a woman sees a doctor or nurse practitioner.

I understand your concern with having more people going on birth control, but you should realize that every single woman's body chemistry is different and that the doctor prescribes the type of birth control pill that best fits the chemistry of that particular woman. Free health clinics are all over the place and they give free or significantly reduced rates for birth control after an exam.

I don't think Pharmacists should be able to prescribe unless it was strictly regulated and only certain types of medications not requiring any sort of physical examination or fluid test of any kind, narcotics as confettiflyer so eloquently put it, or antibiotics to prevent the spread of antibiotic resistance for people requesting antibiotics and receiving them for viral conditions (and probably not finishing the entire prescription)..... after saying that it doesn't really leave much left

 

[coyotefan]

I think it would help in some cases if the pharmacist could prescribe. Like when a patient doesnt have refills and we are waiting for the doctor to fax back... It would be nice to be able to write them a script, even if its a small one with no additional refills until we can contact the doctor.

Otherwise the patient just calls us a hundred times a day waiting to get their script from the doctor.

 

[gabapentin]

Pharmacists are already autonomous in the VA system after sufficient training, such as residency. They have the ability to prescribe and order tests without the physicians signature.

In the retail setting I think the prescribing power should be less than that. Maybe a BTC category will help push this along. I just feel that the pharmacist is not as autonomous as physicians. When you call up the office and correct them, why do we have to ask for permission. Personally, when I am told to call the office and the pharmacist tells me it should be 500mg twice daily, I tell the nurse/receptionist/random hobo if they could change the chart. We need to fight for our rights!

Being able to give the patient a months refill so they stop calling us would be awesome. But I know pharmacists who will write for a months refill and just tell the patient that they need a script for next month.

In many of the states where pharmacists are able to prescribe, they have to be under some physician. For a limited number of drugs, pharmacists should be able to write independently. But those physicians don't want to give up the power.

 

[confettiflyer]

But those physicians don't want to give up the power.

I think that ship sailed long ago with mid-levels sprouting up like weeds everywhere.

As for basic refills waiting for an MD to fax back and pharmacists writing a one-fill script, I think it would actually drive physician bottom lines. First, you can probably cut down on some staff hours especially at larger practices as there's less paperwork to throw around; second, better compliance = less likely your pt will die or less likely you'll have to refer to a specialist (if you're someone's PCP).

Just some ideas.

 

[Jaded03]

They could, but they'd also need someone to interpret the results, and who'd take the samples?

Random interjection. All the above would be done by a CLS or "med tech". They are trained in specimen acquisition, specimen analysis, and result reporting.

 

[atticus27]

I agree with those who disagreed. Pharmacists are essential in catching everyone's mistakes, but it's a lot harder to catch your own. "separation of duties" like medicalcpa said.

Start diagnosing, then start paying for malpractice insurance(No thank you), like confettiflyer said.

Prescribing meds for birth controll and in certain clinical situations maybe, but for pain meds, are you crazy?

I think the only way for a pharmacy to diagnose is to have a set up like those "minute clinics" that are popping up everywhere. Have the NP's diagnose and the Rph fill/consult in the same building. Retail chains must be making a killing off of these clinics.

 

[confettiflyer]

I believe Henry Ford solved this problem of the "jack of all trades, master of nothing" bit with a little innovation called the PRODUCTION LINE.

By paying a $55/hr retail pharmacist to do the work of a... i dunno, i'm making up numbers here, a $35/hr medical technician, there's absolutely no way you can make the numbers work short of hiring 9 year olds from Honduras to be your clerks.

Guess what, you'll have to hire another $55/hr pharmacist to pick up the slack that the original one has now that they're poking around someone's rectum with a q-tip.

Some of you guys need to take economics over and look up "opportunity costs". Just because a pharmacist can doesn't mean it makes a lick of sense.

 

[YiYaoYue]

Maybe we can have a PA/PharmD or NP/PharmD hybrids to learn basic diagnosing so that pharmacists can prescribe for common illnesses. It doesn't make sense in retail since they are already too busy, but makes some sense for a private owned pharmacy.

 

[gabapentin]

I think that ship sailed long ago with mid-levels sprouting up like weeds everywhere.

I don't know about the West coast, but on the majority of the East coast many doctor offices are still old-school. Many offices from my area use PA's to get the basic medical hx. and then they come in and diagnose. The newer physicians are a little more lenient and open to the whole interprofessional concept, but it still exists. I know many pharmacists that have been put on a lower level by physicians many times.

Mid-level practitioners are still under the authority of the physician, in the majority of states.

Prescribing should be more directed to hospital pharmacy. Retail should be limited. I think it would be awesome if some MA patient came in and presents with allergies and the pharmacist could just write a script for claritin.

 

[confettiflyer]

I don't know about the West coast, but on the majority of the East coast many doctor offices are still old-school. Many offices from my area use PA's to get the basic medical hx. and then they come in and diagnose. The newer physicians are a little more lenient and open to the whole interprofessional concept, but it still exists. I know many pharmacists that have been put on a lower level by physicians many times.

Mid-level practitioners are still under the authority of the physician, in the majority of states.

Prescribing should be more directed to hospital pharmacy. Retail should be limited. I think it would be awesome if some MA patient came in and presents with allergies and the pharmacist could just write a script for claritin.

Yeah I've seen it go both ways (autonomous NP's and under the direction of MD PA's). Even with these PA's, often it's a de facto autonomous prescriber since the patient didn't have any interaction with the physician whatsoever (at least from the pt's perspective).

And I agree, at least at my school, they're drilling collaborative practice in like we're an oil field.

 

[SunSprinkles]

IMO, I think that pharmacists should not prescribe and doctors should not dispense for many reasons but one of the primary ones that I don't think has been mentioned yet is commerce...business...bottom line...profit...whatever you wanna call it.

I think that, yes, we all want to believe that doctors and pharmacists are ALL noble people - ALL the time, but the truth is I'm sure there are some that are not. And I'm positive that corporate practices can really ensure that they are not. The system usually functions as a checks and balances system to ensure the best interest of the pt.

The pharmacy makes some sort of profit off the medication they dispense/sell and I think, if they could prescribe they might be more apt to prescribe those medications that they make more profit selling. Think of a retail sales person - yes they want to sell you the best product to suit your needs but they also want to make some money off the sale. This especially applies to community retail pharmacy which is largely run by corporations who are solely concerned about their bottom line...

I've experienced this first hand and I'm sure many of you have also. As a tech at CVS we were encouraged to suggest the CVS brand alternative to OTCs. Mostly because the company makes more profit off of CVS brand - not just because it's cheaper for the pt. Probably the same for generic vs. brand Rx drugs....

 

[YiYaoYue]

IMO, I think that pharmacists should not prescribe and doctors should not dispense for many reasons but one of the primary ones that I don't think has been mentioned yet is commerce...business...bottom line...profit...whatever you wanna call it.

I think that, yes, we all want to believe that doctors and pharmacists are ALL noble people - ALL the time, but the truth is I'm sure there are some that are not. And I'm positive that corporate practices can really ensure that they are not. The system usually functions as a checks and balances system to ensure the best interest of the pt.

The pharmacy makes some sort of profit off the medication they dispense/sell and I think, if they could prescribe they might be more apt to prescribe those medications that they make more profit selling. Think of a retail sales person - yes they want to sell you the best product to suit your needs but they also want to make some money off the sale. This especially applies to community retail pharmacy which is largely run by corporations who are solely concerned about their bottom line...

I've experienced this first hand and I'm sure many of you have also. As a tech at CVS we were encouraged to suggest the CVS brand alternative to OTCs. Mostly because the company makes more profit off of CVS brand - not just because it's cheaper for the pt. Probably the same for generic vs. brand Rx drugs....

Personally i hate that corporations push one over the other. patients should get what is best for them and their situation. I shouldn't have to feel like I'm a car salesman trying to rip people off. If it's the same price as other generics and I know its the same medication then it's perfectly fine by me.

 

[confettiflyer]

I've experienced this first hand and I'm sure many of you have also. As a tech at CVS we were encouraged to suggest the CVS brand alternative to OTCs. Mostly because the company makes more profit off of CVS brand - not just because it's cheaper for the pt. Probably the same for generic vs. brand Rx drugs....

So it's immoral to suggest a CHEAPER alternative to a pt for something like apap, just because the company makes more of a profit off of it? That's crap.

I worked at a bookstore and I was told that the bargain book section resulted in more profit for the company, so if there was a book on the shelf that had a corresponding bargain book, push the bargain book.

You guys crack me up.

 

[confettiflyer]

Personally i hate that corporations push one over the other. patients should get what is best for them and their situation..

Right....because Nexium is SO much better and worth the $120 extra vs. omeprazole.

Your car salesman analogy fails here, pharmacists don't receive kick backs/make more money for pushing brand, they're pushed by their employers to push generics and save pt's money. Unless you're in that kooky camp that absolutely believes Zithromax works better than azithromycin.

 

[SunSprinkles]

Right....because Nexium is SO much better and worth the $120 extra vs. omeprazole.

Your car salesman analogy fails here, pharmacists don't receive kick backs/make more money for pushing brand, they're pushed by their employers to push generics and save pt's money. Unless you're in that kooky camp that absolutely believes Zithromax works better than azithromycin.

weren't we talking about the hypothetical situation IF pharmacists were able to prescribe???
ask a pharmacy manager what the cost: profit ratio is for nexium vs. omeprazole. pharmacy is still a business. it's not invincible to push for a better bottom line. and i think the car salesman analogy was great jeez..gimme some credit for thinking outside the box. lol. =)

 

[SunSprinkles]

So it's immoral to suggest a CHEAPER alternative to a pt for something like apap, just because the company makes more of a profit off of it? That's crap.

I worked at a bookstore and I was told that the bargain book section resulted in more profit for the company, so if there was a book on the shelf that had a corresponding bargain book, push the bargain book.

You guys crack me up.

way to quote and distort. i think i said "Mostly because the company makes more profit off of CVS brand - not just because it's cheaper for the pt." correct me if i'm wrong on quoting myself. i'd say it's a 60/40 motive maybe 90/10 depending on the company you work for. and the immoral part (which i don't think i mentioned morality either...) applies to the hypothetical situation IF pharmacists could prescribe. the idea here is they could essentially in that situation prescribe someone oxycontin for pain when OTC ibuprofen might be all that they need. and with the addictive properties of opiates they would have a customer that would keep coming back for it whether it was more than they needed or not. it could make a pharmacist a true "drug dealer". lol does that analogy float your boat a lil more? sorry that the other one wasn't to your liking.

your bookstore analogy fails here. pharmacists don't read books. you must be in that crazy clique that thinks that books are better than medical journals.

 

[SunSprinkles]

Personally i hate that corporations push one over the other. patients should get what is best for them and their situation. I shouldn't have to feel like I'm a car salesman trying to rip people off. If it's the same price as other generics and I know its the same medication then it's perfectly fine by me.

i definitely agree. i think it would be interesting to hear a testimony from pharmacy managers that have worked in different corporations and privately owned pharmacies.

 

[TTUMike]

If you want to think "opportunity cost" then think about the time lost when a pharmacist has to call a doctor to get vicodin changed to darvocet because of a codeine allergy. This is not the only problem. It happens daily that a doctor prescribes something that the patient can't afford. For instance, does a pharmacist really need to call the doctor to change Rhinocort to Nasacort (which has a generic)?

I am more than certain that if pharmacists were given the ability to write prescriptions for these purpose then no child labor laws would need to be violated.

I believe Henry Ford solved this problem of the "jack of all trades, master of nothing" bit with a little innovation called the PRODUCTION LINE.

By paying a $55/hr retail pharmacist to do the work of a... i dunno, i'm making up numbers here, a $35/hr medical technician, there's absolutely no way you can make the numbers work short of hiring 9 year olds from Honduras to be your clerks.

Guess what, you'll have to hire another $55/hr pharmacist to pick up the slack that the original one has now that they're poking around someone's rectum with a q-tip.

Some of you guys need to take economics over and look up "opportunity costs". Just because a pharmacist can doesn't mean it makes a lick of sense.

 

[confettiflyer]

If you want to think "opportunity cost" then think about the time lost when a pharmacist has to call a doctor to get vicodin changed to darvocet because of a codeine allergy. This is not the only problem. It happens daily that a doctor prescribes something that the patient can't afford. For instance, does a pharmacist really need to call the doctor to change Rhinocort to Nasacort (which has a generic)?

That's why you get your $15/hr intern to make the call, or make your $11/hr tech fax it. Problem solved, patient waits, less time spent by your pharmacist!

 

[TTUMike]

That's why you get your $15/hr intern to make the call, or make your $11/hr tech fax it. Problem solved, patient waits, less time spent by your pharmacist!

First off, anyone who is worked in a pharmacy for some years knows that a fax will not be responded to immediately. In fact, you might not get a response until a couple of days later. Secondly, interns are not always at your disposal. Interns are often there through the summer months and their working knowledge of the pharmacy is extremely limited. So your proposed idea would not work. If you have worked in a pharmacy that does a large amount of scripts (over 700) per day, which I'm sure you have, then you know that giving pharmacists the legal capabilities of changing prescriptions would only help to increase efficiency and thus decrease costs.

 

[confettiflyer]

First off, anyone who is worked in a pharmacy for some years knows that a fax will not be responded to immediately. In fact, you might not get a response until a couple of days later. Secondly, interns are not always at your disposal. Interns are often there through the summer months and their working knowledge of the pharmacy is extremely limited. So your proposed idea would not work. If you have worked in a pharmacy that does a large amount of scripts (over 700) per day, which I'm sure you have, then you know that giving pharmacists the legal capabilities of changing prescriptions would only help to increase efficiency and thus decrease costs.

Pharmacists should not be making therapeutic interchanges without full access to the patient's chart/PMH. This is why pharmacists prescribing under hospital protocol works, but ultimately why it should not be done in any other setting until the mess that is "electronic records" is fixed and some system of access is in place.

You're essentially relying on patients for their history/labs/etc... which is about as reliable as a kleptomaniac delivering mail.

Plus, do you expect the strictly-high-school-educated tech to gather a proper Hx while the pt is dropping off the script? Asking about allergies doesn't count.

Pharmacists (on the retail level at least) are too in the dark to carry out what they're trained to do. I'm not talking about simple interchanges because of a PCN allergy, I'm talking about things like renal impairment or prior psych problems that could affect optimal treatment.

The issue isn't about training...it's about the state of information flow, lack of collaborative practice, and ultimately the financial incentives that will drive this.

So yes...fax the MD, make the patient wait, and verify more scripts. Not worth it to play NP when supporting structures don't exist to assist/compensate you.

 

[SunSprinkles]

found this and must say i was shocked...didn't think the differences between retail pharmacies would be this much....

http://web.wxyz.com/extras/040205-drugchart.html

& look at those % mark-ups on prozac...jeez. that's enough to depress you. haha.

would be interesting to see exactly who these wholesalers are.

and incase you're wondering if this is WHACK...check snopes.com - they say it's true. and we all know that snopes is right about everything!!

http://www.snopes.com/medical/drugs/generic.asp

 

[TTUMike]

found this and must say i was shocked...didn't think the differences between retail pharmacies would be this much....

http://web.wxyz.com/extras/040205-drugchart.html

& look at those % mark-ups on prozac...jeez. that's enough to depress you. haha.

would be interesting to see exactly who these wholesalers are.

and incase you're wondering if this is WHACK...check snopes.com - they say it's true. and we all know that snopes is right about everything!!

http://www.snopes.com/medical/drugs/generic.asp

After personally looking at Walgreen's financial statements, I can assure you that the profit margin is not what you would imagine considering the markup on drugs. You can't forget the millions of dollars a year that Walgreens spends on training, safety systems, and all the other technology walgreens has put in their pharmacies to keep customers safe. This would explain why all the large retailers charge more than your small independent pharmacy.