Montana Viewpoint

December 11, 2006

One by one, symbols of small town Montana are disappearing; train stations, post offices, schools, and drug stores. Drug stores may seem an odd choice, but they belong with the others as hubs of social activity and information exchange (cynics might say gossip). Unlike the others, the loss of drug stores, and the concomitant loss of the unique medical information they offer, can be fatal.

Some of these institutions disappear because of dwindling populations and others disappear because of changing economic conditions. The rapidly approaching demise of the drug store has its basis in economics; an economics that is controlled by both market and government forces.

In a retail sector such as prescription drugs, where prices increase dramatically year after year, people look for cheaper places to buy them. Enter the giant drug discount wholesalers known as Pharmaceutical Benefit Managers, and the chain drug stores like Osco. They are the epitomes of market forces at work. These big guys can buy in volume, negotiate deep discounts with the drug manufacturer, and enjoy an economy of scale that small drug stores can’t even come close to. They can then pass most of that savings along to the consumer.

Part of their savings is due to not having to have a location in every Podunk town, but they can still capture business there by providing a mail order service. That convenience is attractive to the consumer, and so we now have the ability to phone in a prescription, or order it on line, get it in a matter of days, and not even get out of an easy chair to do it.

That’s the market part; the government part of the equation is twofold. First, because most people who need prescription drugs are the poor elderly—or just plain poor—their prescriptions are often paid for by governmental health programs such as Medicaid. It’s a benefit for the consumer, but because the government generally tries to pay the pharmacy as little as possible for the prescription, it narrows the pharmacy’s profit margin, such as it is.

Second, governments themselves have one heck of a lot of employees, and almost all of those employees have a health benefits package that covers prescription drugs, so governments are looking for the cheapest costs there, too.

Montana’s employee benefits program used to contract with the Buttrey’s grocery and drug chain, a Montana company long since bought by Albertson’s; but the state found a cheaper way by contracting with one of the few giant Pharmaceutical Benefit Managers. Now, not only do tens of thousands of Montana employees and retirees get their drugs by mail order, they get them from a mail order firm in Pennsylvania. This is not helpful to our local drug stores or our state and local economies.

Now, in its quest to pay even less for Medicaid drugs, the federal government is cutting what it pays to pharmacies for prescriptions. This isn’t going to help, either. I am here to tell you that small town pharmacies are on the verge of disappearing in America, and from the standpoint of what the social role they play in American small town life, that’s a pity.

It’s also dangerous. Because many people get prescriptions from more than one doctor sometimes a doctor will unknowingly prescribe a drug that shouldn’t be taken with a drug prescribed by another doctor. Occasionally, doctors will even prescribe a drug that shouldn’t be mixed with other drugs which they themselves have prescribed for a patient. Mostly it’s not a big deal, but sometimes it can be fatal to mix them.

There is only one person who is watching out for you here, and that is the person who fills the prescription. One of the major—and terribly overlooked—services that a small town pharmacist provides is advising a person about the incompatibility of their prescriptions, and they do it a lot more often than you would think.

That is a service that has now disappeared in Harlowton, Montana, where the drug store has been replaced with a “kiosk,” which is not much more than a glorified candy machine. It can get the drug for you alright, but it won’t give you any advic—or local news.

If you value your community, not to mention your health, you might want to let your elected officials know how you feel about the importance of having and keeping your local drug store. It will help protect your town’s culture, not to mention your life.


Jim Elliott
Phone: 406-444-1556
Mail: State Senate Helena, MT 59620