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In terms of what's important to customers, 60 percent of pharmacy patients said pricing and insurance is the single most important aspect in measuring pharmacy service, according to the 2007 Pharmacy Satisfaction Digest. In fact, 34 percent of people did not fill at least one prescription in 2007 because it was "too costly," a most significant rise over 2006 (27 percent).

Clearly, pharmacists see it as a big problem. According to an online poll of pharmacists, more than 39 percent believe cost is the biggest obstacle to patient compliance; about one-third believe that the increased cost of drugs is hurting their overall customer satisfaction scores.

There is a much larger cost to consider: the cost of non-compliance. Every year, as many as 140 million prescriptions go unfilled, resulting in more than $100 billion in otherwise unnecessary hospital and nursing home admissions. Of course, the human toll is even greater: as many as 125,000 lives are lost each year because patients don't take their medication as they are supposed to do.

Still, this issue of price is the one issue that resonates most with pharmacists. "There is the financial aspect of it that you have to understand—[customers] aren't always given a lot of options," one pharmacist explained.

One recurring theme among pharmacists that participated in a live panel discussion facilitated by Drug Store News in late June was the shared obligation to serve as a resource for their patients, and not just for information about their health or even the drugs they are taking, so much as how they can help their patients save money.

Certainly, no event did more to shake up the market in terms of drug pricing than the introduction last year of Wal-Mart's generic discount program, which offered customers more than 300 common drugs for $4 for a 30-day supply. In the months that followed, several of its competitors in food and mass answered with variations on the program; traditional drug chains for the most part did not. In all, 23 percent of customers who participated in the Wilson Health 2007 Pharmacy Satisfaction survey said their pharmacies offered a $4 generic program.

According to several pharmacists on the panel, whose chains offer some form of discount generic program, sales are up, profits  are down and volume is through the roof; not exactly a healthy recipe.

"At first we were transferring … 10 prescriptions at a time," noted one such pharmacist on the panel. "For some patients, they said, 'Oh, I'll just switch everything [over].' We're filling probably 100 more prescriptions per day … but it really hasn't helped our bottom line because we still have those patients that just come in for their $4 Meloxicam and nothing else."

Because the additional sales are not reaching the bottom line, in many cases management has been reticent to add staff, and that has created additional stress in those stores.

Then, there are the more simple annoyances. "A doctor will say this Metopirone is on the list, but it's not; it's just regular Metopirone. Then the patient gets mad at us; 'Why isn't it on the list?' We had one doctor call and say, 'Yes, I'd like you to add that to the list for me.'"

In addition, certain state drug pricing laws in California have made the program even more problematic for pharmacists. "California has a law that you can't sell certain drugs below the posted price," noted a pharmacist from that state whose chain also markets a discount generic program. "Some of the drugs that are on the [discount] list we can't sell for that price. Try explaining that to people."