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.