Pharmacy Customer Experience Flaws -- Why Communication Is Key In Healthcare

The other day I was at a major retailer’s pharmacy refilling a prescription. While I waited for my refill, a woman came in to refill her three prescriptions. She was clutching a $10 bill, and seemed to know exactly what she needed and what it would cost. The pharmacy tech found her scripts and informed her that she owed $17.35. The woman was shocked. She verified that the right scripts were in the bag and then asked what had happened. Two of the scripts, she said, were $4 each, and the other was usually $1.99. The pharmacist explained that one of the prescriptions had been taken off the $4 generic list.

The customer was both angry and scared. This was her essential heart medication, after all. Her frustration was understandable — the cost of one of her prescriptions had just nearly tripled, from $4 to $11.35. Likewise her fear. Prescription refill rules mean she can’t have a stockpile of pills at home to tide her over until she could find a more cost-effective option — not to mention that she might need to get a new prescription from her doctor or deal with the delay of transferring her script to another pharmacy. 

And, worse, no one had told her. She thought she had taken care of everything to manage her health — getting to the pharmacy, bringing her money, taking her pills faithfully as prescribed. She asked the pharmacist why no one had told her. He mumbled that they don’t do that.

And that’s where I take issue. Why not? Yes, it takes effort and cost to collect and maintain a database of email addresses and phone numbers, but I can’t imagine many consumers would refuse consent to be contacted when an important medication or price change takes place. This retailer probably has a pharmacy — and a list of $4 generics — as a loss leader for its larger retail business. It’s a tool to get people in the door. But entering into the healthcare market comes with a responsibility — and potentially large brand implications when you leave your customers wanting.

As I see it, this retailer could have handled this in one or both of two ways. First, they could have created an outreach program that would notify customers by automated email, phone message, or text when a significant change in price or availability of one of their scripts takes place. Second, they could allow a one-fill grace period where they inform customers in person that the price has changed and that this is the last time they’ll be able to fill at the old price. Either option would allow customers time to either find another medication that they could afford or find a more cost-effective place to fill scripts. The latter would potentially lose a customer, but at least it would leave the brand intact.

In the end, another patron took pity on the woman at the pharmacy. While she was trying to figure out just how many individual pills she could afford for her $4, another customer handed her a $20. The woman didn’t want to accept the charity, but when the other customer reminded her that, if she didn’t, she’d be in the same boat in just a few short days, the woman relented. Her thanks were effusive — she said this would give her time to talk to her doctor and figure out a new, cost-effective option. And she carefully handed back to her benefactor all of the change she received.

I think the lessons here are simple. For $7, this retailer trashed its brand by not treating its pharmacy customer fairly. Access to prescription drugs is a critical element of healthcare. Holding customers hostage to arbitrary and changeable formularies and price lists without the safeguards that help them manage their health decisions proactively and cost effectively just doesn’t cut it in an age of ubiquitous communication.


Technology is right there, just takes the will to make it happen

Best part of the story is of course that a stranger stepped up to help. I <3 that!

The sad part is that I would bet all the information and core systems needed to pull off a fully automated, and mutually beneficial, round of communication to help patients already exists. The pharmacy would have at least one method of contacting the patient - mailing address, home phone number, email address, mobile phone number.

As soon as the medication went off the list, the automated system you described could be kicked off. The pharmacies systems know when prescriptions are up for renewal, they know which medications are on the list, and they have the contact info. All you need is the tech to bridge the existing systems and the patient.

And I'm pretty confident about the existence of that tech because (full disclosure) the company I work for makes software that does this all day long for lots of companies for both employee and customer communications.

Abbas Haider Ali.

"Treat" patients with the Big Data insights

I agree Liz, thank you for sharing the story regarding the surprise at the cash register for a fellow customer. I am sure many readers have experienced "sticker shock" at the pharmacy counter, and more and more Americans are looking at the lack of cash in their hand and forced to make tough trade offs, a little warning can go a long way. I carried my thoughts from your message a bit further in my blog.

Please feel free to share your thoughts further.

I think you have no idea of

I think you have no idea of how things work in a pharmacy. I know because I work in one. I also work for a company that has a $4.00 list of generics. We do not have enough manpower, due to payroll restraints, to call every person on a particular drug when the price increases. Our company makes sure that we only have time,with the limited payroll hours of help that we have, to fill all the prescriptions, answer the phones, call doctors for refill authorizations, handle insurance claims and insurance rejects, watch out for drug interactions, counsel patients on their prescriptions and over the counter drugs, ring up the prescriptions, reorder the drugs we use, do immunizations, read all the company emails, and multiple other tasks. It is very stressful and we do not have control over the company's decision to increase the retail price of drugs (which is usually due to the drug manufacturer increasing the cost of the drug to the point that our retail must increase so that we are not losing money on the drug). We cannot give drugs away below our cost. Anyone with any business sense would know that.

Interesting note and feedback

Liz is, of course, accurate in her observation. The underlying issues of who's responsible for what are very interesting here -- the consumer has an expectation and limited vision on what changes when until they "discover" it. In this case they discovered it at the point of service because pharmacy stuff is "real time". In the case of doctor visits or other interactions the customer surprise may happen after the service because customer pricing isn't known until after the service. It's really, really ugly for durable medical equipment where the customer may find the price but be mortified by how much it costs.

The interesting question: if the customer doesn't know the costs or the drivers and has no real choice that they can see do you expect anything but frustration? Frustration with the pharmacy, frustration with their health care plan, frustration with their doctor or hospital. The hallmark of healthcare in 2012-2014: confusion, frustration, fear, dobut

Thanks for the feedback

Thanks for the feedback and responses. I agree that the responsibilities for these sorts of issues are broad, and include both the patient and the pharmacies. The frontline pharmacy staff are often the least empowered to make changes. In this case, the pharmacy staff was as polite and helpful as they could be -- they were just constrained by the rules put in place by the business. I'm not advocating that pharmacies give away products at less than cost (though some choose to do so). But let me be clear. The choice of when and how to roll out price changes _is_ in the control of the pharmacy management. If they know a change is coming, I believe they have an obligation to make those changes clear to consumers -- while consumers still have time to make alternative arrangements if needed. The pharmacy business is not like selling groceries or clothes -- consumers do not have unlimited choices of where to go. Even if they are not constrained by their insurers it can still take days or weeks of phone tag to transfer a prescription or get their doctor to send in a new one. I also believe that the imperative for clear and timely communication is higher in health than in many other fields.

Who raises the cost...

The core issue, Liz, is who raises the price. If it's the pharmacy I agree with you they have control and arguably responsibility. This was an opportunity for the pharmacy to shine in customer service and gain more consumer confidence.

It's not hard to postulate and back up with some real data even that the consumer has no clue of the cost of the product they are attempting to buy and that the cost increase may not be done by the pharmacy. The medical plan may have changed their formulary which is worse than Greek to the customer and at least one step away from the pharmacies sphere of influence and maybe even ability to explain.

I do tend to hit the pharmacy once every month or so and most discussions about price I overhear -- their seem to be many -- are more deeply involved with the plan's benefits.

Real data here would be interesting -- are the most common problems at pharmacy POS:

1. Plan changes/formulary changes
2. Pharmacy price/policy changes
3. Provider related prescribing issues
4. Customer misunderstanding/poor information or responsibility taking

In a world where the disruptive factors are many and many not caused by the pharmacy themselves it's easy for the pharmacist to pass it off as someone elses issue -- a symptom of the overall systems lack of economic drivers that are clearly understood. Each participant blames someone else usually with many fingers pointed to the insurance company who tends to be in the middle of most of the financial transactions. It's easy for the insurance company to blame the providers, the pharmacies and the drug manufacturers as well -- hey, it's insurance and the vast majority of the funds are pass through. The insurer is doubly blamed because if they are effective at negotiating rates with other parties they are hated as well.

Health insurance today seems to be 40% risk management, 40% negotiating skills/weight and 20% press management (value your good name in the community). The odd part here is the consumer -- not the member or patient but the consumer -- values the service by selecting the lowest price plan in many cases but tends to detest the process by which the lowest price is created.

A Good Person

I read and read hoping to see that someone had stepped up and had helped this lady pay for her prescriptions. We happily make donations to disasters in far away lands but here was a chance to make a real difference here. Hooray.