On Consumerism: Are gas stations preferable to pharmacies?

By Arthur Vidro
By Arthur Vidro

Gas stations used to be called service stations. And why not? They added oil, coolant, and anti-freeze to your engine and air to your tires. They did major and minor car repairs. Every station had a mechanic.

Nowadays the stations don’t do repairs and pretty much just sell gasoline, lottery tickets, beer, cigarettes, and groceries.

Despite the massive cuts in service, I praise gas stations across the land.

There is never confusion as to the price of gasoline. Stations use the largest price tags on the street. You can read them half a block away.

Contrast that with the insanely convoluted pricing of prescription drugs.

Suppose you’re taking two pills of a drug every day. Then, after some improvement, the doctor cuts you back to one pill a day.

One would think that by needing fewer pills of the same drug, the price you pay would come down. But it doesn’t. The industry reply is you’re paying for a 30-day (sometimes 90-day) supply. It doesn’t matter, they say, if you’re consuming fewer or more of the pills than you used to.

So there is no financial incentive to reduce one’s drug intake.

A relative of mine once worked hard to get off an addictive prescription drug. But when she was scheduled to take a civil service exam, she wanted that amphetamine again, just for the test. Her doctor agreed to prescribe a single pill.

I went with her to the drugstore. Her copay for one pill was the same as it had been in the past for 30 pills. I asked the pharmacist if this was a mistake. No, he explained, not a mistake. The price is per fill or refill.

Picture it. The price for a single pill was the same as the price for a bottle full of dozens of the very same pill. The number of pills had nothing to do with it.

Nor, as I later learned, did the strength of each pill.

Suppose you take a 100-milligram pill twice daily, then reduce it to 75 milligrams twice a day, then 50 milligrams, then to 25 milligrams just once a day.

The pharmaceutical industry doesn’t see any need to change the price you pay. No matter how many pills you receive, no matter how many milligrams of the drug, your payment does not change.

What a crazy system.

It gets crazier, as I learned this summer.

To help my breathing, I puff every day on an inhaler. The device contains 120 “actuations,” a fancy term for puffs. But puffs are not pills. The pharmacist cannot add puffs to, or take puffs away from, the device. The manufacturer has put 120 puffs into each inhaler, and 120 it remains. You can’t get that inhaler with a different quantity of puffs.

Early this year, I brought an inhaler prescription (which included 11 refills) to Sugar River Pharmacy in Claremont. Each time I received an inhaler, I spent a $50 copay (and the insurance company paid a given amount too). No problem.

But then, in June, Sugar River Pharmacy disappeared. One week they were open as normal, the next week they were closed with a little sign on the door saying customers’ prescriptions had been lassoed by CVS Pharmacy.

Yes, CVS had bought Sugar River (Claremont) solely to acquire its prescription business. According to a pharmacist who was employed by Sugar River, one condition of the sale was not to tell customers about the sale until Sugar River’s final week of operation. So for most customers there was no warning.

Sugar River Pharmacy in Newport is still in business; only the Claremont branch was sold. Nevertheless, my prescription had been moved to CVS, and was no longer in Sugar River’s system.

I went to CVS to renew my prescription, a $50 bill in my hand. They said the price was $100.

Yes, double the price. I asked for an explanation. The pharmacist at CVS said the prescription had been written for me to take two puffs a day, and since there were 120 puffs per device, I was receiving a 60-day supply. Therefore, I had to pay for two months, not one.

I pointed out that every month I had gotten the same device from Sugar River for a $50 copay, and that clearly, since the prescription had been written with 11 refills, the intent was that each device was for one month and that I should be able to get a new device each month. CVS said Sugar River probably made a mistake by not charging me $100.

I left empty-handed. Eventually, I got my doctor (through a “telephone appointment,” for which I may yet be billed) to write a new prescription, specifying I take four puffs a day. (I usually take three a day. But until then nobody in the industry had been counting.)

Once CVS received the new prescription – for the very same device, except the wording on it now stated I was to “inhale two puffs by mouth twice a day,” the device became cheaper. The very same device they were telling me was a two-month supply and would cost me a $100 copay to receive, was now a one-month supply to be had for a $50 copay.

So, it seems that for pills the drugstore is charging you by the refill, regardless of dosage or quantity. It doesn’t matter how long that bottle of pills will last you, be it a day or a month or longer.

However, for a little inhaler, the drugstore ignores its pill-pricing system of charging you per refill, and instead charges by how long it will last you.

Now let’s apply this lunacy to gas stations.

First, the pill-pricing logic. Pump some gas, doesn’t matter if it’s one gallon to fill a gas can to put into a lawn mower, or 40 gallons going straight into your car, you pay the same total price. You’re being charged per pumping, not per gallon. If you use a lot, there’s no incentive to use less. If you use a little, there’s no reason not to start using more.

Now let’s apply the inhaler-pricing logic. Pump some gas, but first the station needs to see your odometer to determine how many miles you’ve driven since your last purchase; then, given the expected miles per gallon of your vehicle’s make and model, it determines what a monthly supply should be for you. If you desire more than that amount, you’ll be charged considerably extra. (That’s only if your insurance plan covers this gas station. If not, all bets are off.)

I’d like to buy a gas station just to see a pharmaceutical executive drive into it, go up to the pump and put in, say, 23 gallons. At the next pump a woman he doesn’t know, but who drives a car identical to his, is putting in an equal 23 gallons of the same grade of gasoline.

Then I’d saunter over to them, tell the woman her gasoline would cost her $50, and then I’d walk up to the big-shot executive and tell him to pay $100.

He would protest. He had put into his car the same type and quantity of fuel as the woman had put into hers. And they had matching cars, so their miles per gallon shouldn’t vary.

“Ah,” I would explain, “but she drives more than you do. For her, the 23 gallons is a one-month supply. But for you, the 23 gallons is a two-month supply. So you have to pay double. You see the logic of that, don’t you?”

But no, gas stations charge based on how much fuel you use, not how long it will last you.

Perhaps we should consider having gas stations fill our drug prescriptions.

Arthur Vidro’s latest short story, “Which Casino?” appears in the November 2020 issue of Mystery Weekly Magazine.