Dr. Malia Reckons

Last winter, a local supermarket pharmacy started offering free antibiotics. Many common antibiotics were included, and a prescription for up to 2-weeks worth could be gotten at no cost, not even a copay.

Besides getting the supermarket chain some good (free) publicity, I suspect the program got it extra business. Since the antibiotics in the offer tended to be the least expensive, the store likely made back the money, and then some, from folks buying other supermarket items while they waited.

At the time, I was interviewed about the program by a local newspaper. That article can be found at -- http://www.wickedlocal.com/mpnnow/towns/fairport/x1708113095/Wegmans-offering-free-antibiotics.

My feelings on giving free antibiotics are mixed. My thoughts turn to the economics of the program as well as the clinical risks involved. I wonder how doctors and patients should approach this issue. And if this is a sign of things to come in health care.

I do think the program is a good business decision for the large supermarket pharmacy. But, I also suspect it could hurt small, private pharmacies which may offer fine, personalized care and service but can not afford to match the no-charge medicines. I was quoted in the article:

“Those small businesses often offer personalized service that is convenient and local, and I believe many patients would benefit from just that kind of care and attention,” he said. “With the marketing of the low-cost and free prescriptions at the large-store pharmacies, I fear the small community pharmacies may lose business and patients unwittingly may lose a service they dearly need.”

Yet there are many patients who are helped financially with this program even if they are only saving a few dollars. Those with no insurance for medicines likely benefit the most.

But I also worry about the pressure on doctors and patients to make decisions based on the out-of-pocket costs of the prescription. Initially, when the program was to be short-term, I had a few patients request prescriptions they would hold in case they needed them after the program ended. I declined each time -- besides possible insurance fraud, I do not like antibiotics sitting around our medicine cabinets and potentially being used inappropriately later. But there are other potential clinical risks, not the least of which is the unconscious shading of our decisions by finances. The article reported me saying:

“Patients will have to be especially careful that the treated condition is improving and, if it is not, they need to check with their physician for a possible change in antibiotic therapy,” he said. “The pressure to prescribe just the least expensive medicines means we all — doctors and patients — have to be sure the treatment is proper and effective, otherwise we are at risk of being penny wise and pound foolish.”

Considering the economics of health care and insurance companies, I also find it interesting that I, as a physician, am "contracted" with an insurance company and must charge a copayment for an appointment, but a pharmacy can drop a charge and "eat" the costs as they drum up other business in their store.

Is that the face of "free market" medicine if we move in that direction? I worry that small-office private primary care doctors will be crushed by large medical groups that off-set costs in one area to build up volume in another if these marketplace behaviors expand throughout health care.

A supermarket can make more money by linking their business to health care -- getting more customers in the door for free antibiotics will likely lead to more money spent on groceries the same day. It is a good business model. But, is it a good health care model?

Will I someday have to open a bookstore/coffee shop in the front room of my office and then not charge my patients any copay to compete with larger offices? And, if I do, will it be enough to "compete" against the false value of "health care supermarkets?" Will my patients benefit?

Free antibiotics. A good thing? A clinical risk? A sign of things to come? Let's talk in ten years.

--Timothy Malia, MD