Let's Compare Pharmacies

Experiencing the US and Portugal

Last week I wrote about drug prices in Portugal versus the US. Today, permit me to share my observations when visiting a Portuguese pharmacy. Spoiler alert: you will not find wine!

The largest pharmacy in downtown Cascais.

US Pharmacies

I have been told I can be very direct…so let me be clear. I hated going to a pharmacy in the U.S. Yes, there are “convenient” drive-through windows … but that typically means two “convenient” trips to the damn place. One to drop off the prescription and the other (after receiving a text 2 hours later) to pick up what you need. If you feel like crap or are in pain, you really shouldn’t have to wait or drive twice!

The truth is my hatred for pharmacies increased during the last few years of my mother’s life. She relied on me for grocery and pharmacy runs. That meant, in addition to her medication, I needed to buy personal hygiene products. I don’t care how much paper lace you put on them, they are still diapers. And I always wanted to grab the store microphone and exclaim, “These aren’t for me!” This must be how men feel when their wives ask them to pick up a box of tampons. (Note: I finally switched to Amazon when we moved to California…wish I had thought of that sooner.)

But it just wasn’t my personal embarrassment. It was also the absurdity of the store layout. To get to where the drugs were dispensed you had to walk through aisles of makeup, toys, frozen pizzas, potato chips, cookies, wine, seasonal decorations, etc. I estimate that the typical chain pharmacy in the states is 10-15% drug store and 85-90% everything else. And it made me wonder, do American pharmacies intentionally only sell unhealthy food choices?

Every pharmacy displays the green cross…easy to spot.

A Farmácia

Permit me to compare this to a pharmacy in Portugal. Yes, there are non-drug products in Portuguese pharmacies. You will find skin cremes, orthopedic shoes, etc. But you will also find five or six stations where English-speaking pharmacy technicians, wearing impeccable white lab coats, will assist you. I have never encountered a line at the pharmacy, pictured above, which is just a few blocks from our apartment. And since I have already had the opportunity to try out the Portuguese health system, I have made quite a few trips.

My most recent trip.

Permit me to recall my most recent experience. It began when I texted my physician asking to refill my gabapentin and Vimovo prescriptions. Yes, I texted. This is not a new “Covid” thing. This is Portugal. If you have a prescription on file with the health system (even if your doctor was not the prescribing physician) it can be refilled via text or email. (I have taken gabapentin for years due to persistent nerve pain following my many knee surgeries. The Vimovo is a result of my elbow surgery in July.) I texted my favorite orthopedic surgeon and later that day got an email from CUF hospital with the prescription attached. I also got a text with a link to the prescription. If you like paper, you can print it out and take it to the pharmacy. Or you can save a tree and just take your phone.

The person in the white coat will scan a bar code on the prescription. Depending on the size of the pharmacy one of two things will happen. S/he will either walk a few steps and retrieve a box from the shelf or (magic) a box will swoop through a tube to their station. There you have it…no hand-off…no counting of pills…no printing of labels…no return trip. The box has “all the terrible things that can happen when you take this drug” insert in it. The box even has braille bumps on it.

Things to Know

Because Tricare for Life was both our supplemental and drug insurance in the States I used XpressScripts. Prior to coming to Portugal, I asked them to provide an additional 3-month supply of the medication because “I was going on vacation”. Therefore, I had a 5-month supply of gabapentin when I arrived. It turns out, had I brought a prescription bottle with unfilled refills, I would have been able to get the medication by taking the empty to a pharmacy. (At least that is what I have been told by other expats.)

Now gabapentin is not a narcotic. In the US, the pain clinic that prescribed it wrote the script for 12 months and required me to come into the office once a year. The typical office visit (billed to Medicare and Tricare) took under 5 minutes and went like this:

“All good?”

“Yep”, I replied.

“Okay, we’ll send it to the same pharmacy we have on file. See you next year.”

The physician here wrote the script for six months but led me to believe a simple text in six months was all that is required.

The other thing you will want to check out is the approved formulary. You can find it online. If a medication is on the approved formulary in Portugal it is covered by the national health system. If it is not, you pay retail. You will recall the Vimovo example I explained last week. (If you have not already read this post and currently live in the US, SIT DOWN and read it now. That’s an order!)

I was explaining to the pharmacy technician what Vimovo costs in the US. This was only after he apologized to me that it “was so expensive”. He then went on to explain that if my doctor wrote two scripts (one for the anti-inflammatory and another for the stomach protector) it would be covered as both are on the approved formulary. So instead of €22 it would have been about €1.

I am capable of taking two pills; so next time, that is what I will do.