Do Most Pharmacies Normally Stock Virtually all Drugs and Sizes?

Factual Questions
1

I am mainly interested in manufactured pills rather than things that have to be custom compounded. I know that some pharmacies won’t keep drugs with street appeal like Oxycontin on hand but will order them for you in 24 hours.

However, I have had plenty of prescriptions in my life and some of them seemed pretty exotic to me. I have never had a pharmacy tell me they didn’t stock my prescription. Sometimes they were out of a size and had to call the doctor for a substitution but I understood that they normally carried it but were just out.

It seems like pharmacies carry virtually every commercially made prescription pill in almost very size. However, when I look behind the counter at the stock shelves, they look neat but a little barren.

How many drug and size combination does a typical pharmacy stock and how does that relate to the combinations available?

2

You may be suprised as to just how many bottles you can fit in a particular area of shelf space. A one-foot wide, eight-feet tall section of shelving can hold hundreds of bottles. A particular pharmacy near me has about 30 such one-foot sections, along the walls and a central panel. Plus, there’s the automated filling machine, which has the most common 50 or so medications.

Beyond that, they don’t have to stock every kind of medication.

Although pharmacies regularly stock many different medications, they can have a long shelf life. That means if someone had a prescription filled that the pharmacy had to order, they could have had some left over, and they’ll keep it around until the expiration date, which could be several years in the future.

As you mentioned, many pharmacies can get next-day deliveries. That would allow them to carry a larger selection at the expense of deep inventory, as they can be assured of a resupply soon after they run low or out.

Finally, if you know when a patient is likely to get a refill, you can order in anticipation, thus only obtaining additional stock when necessary. Computer-based pharmacy operations can make this part and the previous part automatic.

Some medications, like creams or liquids, can be shipped and stored in powdered or concentrated form. The pharmacist would then prepare the final medication when needed.

Perishable medications, like insulin, or bulky items, like insulin syringes, may have to be ordered more often than other medications.

Obviously, large pharmacies, like in hospitals, can stock much larger quantities and types of medications.

3

I have a question, if I may, for Cleophus.

My husband recently injured his back and was given a script for Vicodin. When I gave him the bottle, he counted the pills and announced that it was one pill short. I asked him why he bothered to count them, and he said he’d thought the last bottle was short, too, but hadn’t counted them. (He was taking them as ordered and they should have lasted a certain number of days, but didn’t.*)

I considered calling the pharmacy, which is located in a chain grocery store, but thought that they probably would write it off as a call from a pill-abuser who hoped to get an extra pill out of it.*

I never did anything about it, but I’m wondering if I had, what would have been the best approach? Shouldn’t the pharmacy be informed that someone’s swiping pills?

*Note, we have no one in our home that may have been taking them.

** A pain specialist I see has huge signs all over their office and make you sign a form that medications will not be replaced, regardless of if they’re stolen, dropped down the drain, etc., so I assume that there must be a big problem of people making up excuses to get more drugs. I imagine pharmacists hear a lot of these claims.

4

Thanks Cleophus, that makes some sense.

The thing that got me ask this question was a trip to my home town for the first time in 13 years a few years ago. My home town is tiny at about 1,200 people and is in a very depressed region of Northern Louisiana with not much around for a long way. It only has one drug store with the same pharmacist that has been there my entire life.

I was not in the best mental health at the time and was fighting Bipolar disorder with all my mite. When I was visiting old friends that I hadn’t seen in over a decade, I realized with horror that my medication was running out and I had no idea what to do.

The next morning, I walked into the pharmacy, they greeted me like I had never been away a day, and I told them my problem about my medication which my Boston area doctors had told me were cutting edge treatments but in unusual doses.

The pharmacist said, “Let me see what I can do.” and went out back. Two minutes later he asked “Tell your Daddy I need my big hammer back. Do you want me to put this on his bill?” and gave me my medicine.

There isn’t even a doctor in the town and the nearest psychiatrists are about 40 miles away. I have no idea why they had multiple unusual medicines unless they just subscribe to everything in a catalog from some source.

5

I was given a prescription once by some specialist. The medication was available ONLY in the pharmacy at the hospital where the guy had an office. I called the usual stores (Walgreens, grocery stores, etc. and no one had it in stock). Of course it was much more expensive at the hospital than it would have been elsewhere.

I’m sure the Dr. had some sort of arrangement with the hospital, and I’m sure there were equivalent medications he could have prescribed.

But, that is the only instance where, generally speaking, a medication wasn’t available at most pharmacies.

Bob

6

In high school (a little over 20 years ago) I worked for a corner pharmacy. They couldn’t afford a big inventory. They often got prescriptions that they could not immediately fill. Sometimes they’d just call and order it, telling the customer to come back the next day. If we got an urgent order (we–I--delivered, so we often got hospital prescriptions for delivery to nearby homes), our pharmacist would call one of his buddies. I’d be sent to another local pharmacy with some cash and a note, and return with what we needed. Our pharmacist would then package and label the stuff, and I would be sent to deliver it.

I have also had to wait for supplies to arrive before my prescription was filled.

7

I suppose I should have mentioned I’m not a pharmacist. I work for a chain pharmacy, and have to be familar with their basic operations, but I don’t usually work in the pharmacy.

Anyway, there’s no harm in asking. If it’s a major retail pharmacy, it’s very unlikely you’ll be brushed off (customer service and all that), and the pharmacy should be able to audit the number of pills they have in stock vs. the number of pills that should have been dispensed to date, if it comes to that. If this has been an ongoing problem definitely bring it up.

8

My daughter’s asthma medication was frequently not in stock in any pharmacies near where we live; they’d have to order them. This included the little local pharmacies (two of them) as well as the big chain pharamcies like Walgreens and Savon. Of course, now that we don’t have health insurance, it’s all academic anyway; fortunately, my daughter seems to have grown out of the asthma.

9

I have really been enjoying Cleophus’ answers. This is a field where I don’t know any of them. The sensation of someone else’s expertise. Very nice.

I often autopsy people who have died from prescription drug overdoses, usually accidental, almost always multiple. The list of excuses recorded from their broken lives is very impressive. I remember a doctor’s letter to a patient that went something like “I have been in communication with Cleophus Jones, my partner. When you told me on October 12th that you had no more Vicodin and had not received any since the last time you saw me, Dr. Jones tells me he had given you a script for 20 on October 10th. Dr. Jones and I feel you should obtain all your medications from a pain management center from now on. You lying, stealing, drug-seeking bitch.” No, he didn’t say that, but I could just tell he wanted to.

10

Getting back to the OP, I remember a problem a few months ago (can’t remember what state it was in) where a pharmacy wasn’t carrying birth control. They got in trouble based on the fact that in that state, pharmacies must carry ‘all commonly prescribed medications.’ But I’m not sure if ordering them for the next day counts as carrying them or not.

Is that really true? If I was in enough pain to require oxycontin and the pharmacy didn’t have it, I’d go somewhere else since I’d probably not want to have to deal with the pain until tomarrow.

11

You could count them before you accept delivery at the store.

12

It is true in Massachusetts or at least they say it is. There was a big string of pharmacy robberies a few years ago and the sole goal of the robbers to to take their Oxycontin. In response, pharmacies often have a sign prominently displayed saying that it has to be special ordered.

However, I was once prescribed Oxycontin after a surgery and they filled it right away even with the sign so maybe it is just a trick.

13

Sounds a bit unethical to me.
Usually the drugstore can get almost any drug from the wholesaler in 24 hrs.

14

How would the auditing help? In my situation, Hubby was supposed to be given, say, 30 tablets. If someone was taking one pill from each prescription, it would show that 30 pills were dispensed to Lissa’s Hubby on [date] and their stocks would be just fine. The customer is the one who shows the loss, not the store.

15

Would you be willing to share what the medication was? That could give insight as to general availability and alternatives.

16

An audit would help to show if someone’s just being sloppy in counting, but you’re right, it won’t show if somone counts out 30 pills, pours 29 into the bottle and pockets the 30th pill.

**Cleophus ** - any idea how the pharmacy would go about auditing? Unless the pharmacy is brand new and only opened last week, how would they be able to track pills to that level? I’m envisioning a nightmare of bulk jars of 250 pills, and in the past two months, they’ve had seven people with Rx for 30 pills, four of those got refills, someone else had an Rx for 14 pills, and… let’s stop and count. 7x30 new, 4x30 refill, one odd-ball of 14 pills… 344 pills. Opps, only 250 per bottle, so there should be one empty and one with 156 pills still in it. Count it out and find 157 pills. Did one of those twelve prescriptions get shorted, or did the manufacturer slip in an extra pill?

I certainly wouldn’t want to get into that sort of effort.

As for pharmacies being able to predict that a given medicine will be needed on an ongoing basis to cover refills, I wish the pharmacy I go to could grasp that. I take an unusual dose of thyroid replacement. Odds are that I will be on that stuff for the rest of my life. Certainly, for the past ten years, I’ve been taking one of those things every single day, and every 30 days, I’m getting a refill. Apparently, they only order the stuff in 100-pill bottles, as it seems like every four months or so, I have to go back the next day as they had to order it.

Back to the question of how many meds a pharmacy stocks. There are fewer to pick from that you might guess. The formulary for my insurance plan lists fewer than 1000 medications, and some of those entries are for different forms (eg: regulara or extended release) of the same med.

17

Some thieves are very organized, but some miscount. If they notice wonky numbers in an audit, it gives them some data to work with.

18

I take Lortab, a painkiller, and very often the pharmacy can only give me, say 16 pills and then they order in the rest of the prescription and i get it in a day or two, and that’s in Chicago. I’ve also been told that since I have prescriptions for controlled substances, I can’t transfer them out of that pharmacy, for fear of doctor shopping and concealing a scam or an addiction. I have to go to the same place every time.

19

Have you spoken with the pharmacist about this? Many years ago I was taking a rather unusual medication and after going through a similar process, I spoke to the pharmacist (this was an old time neighborhood pharmacy, not a chain, which may make all the difference), and he agreed to make sure the medication was available for me as needed.

Alternatively, perhaps you can call them a day in advance, tell them you’ll be in to refill the meds, and ask them to have it there when you bring in the script?

Just some thoughts, anyway.

20

That’s pretty much what I do - I call it into the automated phone system, and if it says the order will be ready on Monday, I just wait until Wednesday to go there.