Danger Lurks at Big Box and Chain Pharmacies

This article popped up in a dozen places over the past week or so. The New York Times, the Chicago Tribune, Axios, even QVC!

How Chaos at Chain Pharmacies Is Putting Patients at Risk

Reading it will curl your toenails and raise the hair on the back of your neck! You’ll wonder how you have survived your Walgreens or CVS drug prescriptions.

But while I applaud the honesty and real-life approach to the exposé, I am as frustrated with this article as I am with so many others….


Because while articles like this expose the awful truth of a situation that can too easily put us in danger, rarely – and this one is no exception – do they provide alternatives, or tactics for protecting ourselves. In effect they say, “Isn’t this horrible? But hey! You’re on your own to figure out what to do about it!”

So, if you typically get your drug prescriptions filled at one of the big box or chain pharmacies like Walgreens, CVS, Rite-Aid,  Walmart, Publix, Wegmans, Costco, Target, or others, and yes, let’s throw in those mail order pharmacies like Express Scripts or CVS Caremark  –  here are some points to understand.


  1. Be aware that big pharmacies are focused only on making money – period. Now, there is something to be said for good customer service and believe me, no one at any pharmacy wants to harm you. But the incentives for filling too many prescriptions in too little time by too few people are all baked into the business model. Those employers’ tell their staff: “Do it our way with too few people and too little time or you will lose your job.”
  2. Once you understand the duress they are under, you also need to understand how they are staffed. There is usually one licensed pharmacist available, then a group of “pharmacy techs” who are trained to fill prescription bottles properly. Pharmacy techs are good people, but their training is nothing like a pharmacist’s. They require only a high school diploma or GED, although some (but not all) pharmacies will hire only someone with an AAS degree in pharmacy tech. There may also be a cashier behind the counter who has no pharmacy education or training at all.
  3. So, against those two backdrops, you can understand that overstaffed, and possibly under-trained or educated people, are tasked with making sure you get the right drug, in the right dose, with the proper instructions, barely considering that each dose impacts – positively or negatively – your quality of life, and quantity of life. One mistake can lead to debilitation or death (examples here). The pharmacist should also be reviewing the prescription to be sure there are no drug conflicts before you receive it. But as you can see – who in that pharmacy has time to do that?

We smarter patients need to protect ourselves:

  1. pharmacyBe sure to ask your doctor to explain the details of your prescription before your appointment ends: drug name, dose, frequency, etc. Be sure you also understand why it was prescribed – what is it going to fix or control?
  2. If you received a paper prescription, ask for a copy before handing it over at the pharmacy so you can double check it when you pick it up.  If your prescription was electronic, then your doctor’s office can give you a copy before you leave. Ask for copies of all prescriptions and instructions for taking them from the doctor’s office.
  3. When you pick up the prescription, double check it, including
  • Compare drug names carefully! Many drug names are similar and confusing and you want to be sure your drug in the bottle or box is what was intended. Examples:
    • Flonase is for allergies, but Flomax is for prostate problems
    • Aciphex is for reflux, but Aricept is for dementia or memory problems
    • Celebrex is for pain and inflammation, but Celexa is for depression

    There are dozens more of these similar name drugs that can wreak havoc in a human body they were not intended for (like – ladies – maybe you have allergies, but OMG what would happen if you took a drug for prostate problems?)

    Ask the pharmacist (not a tech) to check the drug as dispensed to confirm it’s the right prescription with the right instructions. Ask if there is anything else you should be aware of (like side effects) if it’s a new drug for you.

  • If the prescription is for something you have taken for a long time, then compare the new to the old. If it’s a brand name drug (one which begins with a capital letter) then it should look identical in size, color, formation, and even the little code printed on it. If it’s a generic, then it may look different which, of course, requires even closer review.
  • One way to shortcut all this is to choose a smaller, independent pharmacy for filling your prescriptions. One hallmark of smaller pharmacies is that they pride themselves on their care for their customers. They may be a bit more expensive (not always) but the safety may be worth it. The bonus is that you are also investing in your local community each time you shop locally.
  • If any of this seems overwhelming or more than you feel competent to handle on your own, contact a patient advocate to help you. In fact,If you are experiencing unusual symptoms, it’s possible they are due to a drug conflict. A patient advocate can provide an objective review of the drugs you take, then help you talk to your doctor about making important changes.

The one point we ALL know about the healthcare system is that we must protect ourselves and our loved ones from mistakes so we don’t end up being statistics. Keeping a close eye on your drug prescriptions is a must-do.

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1 thought on “Danger Lurks at Big Box and Chain Pharmacies”

  1. Excellent post with very useful information! Just one more thing to add: take the 30 seconds it takes to actually count the number of pills in the bottle – especially for controlled substances (narcotics, anti-anxiety meds, some seizure/muscle spasm meds). If you walk away from the counter only to find missing tablets once you get home, it will be difficult to recover those missing tablets.

    As of March 1, 2020 prescribers are required to log in to a prescription monitoring website when prescribing controlled substances, and they will be unable to submit a refill prescription before it would be due based on the number of tablets they originally prescribed – no matter how many you actually walk away with from the pharmacy. So count those tablets!

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