Ask the Pharmacists
Why Are Nonprescription Items Behind the Counter?

By Joyce Gemperlein
Special to The Washington Post
Sunday, December 25, 2005

As I was waiting in line to pick up a prescription the other day, my gaze fell upon shelves behind the counter that hold an odd assortment of items, among them: Breathe Right strips for snoring, smoking-cessation kits, sitz baths for hemorrhoids (or whatever), Gillette Mach3 razors and a "ZNP Bar" for advanced dandruff.

I was 16th in a line that was barely creeping toward the register, so I had time to wonder why this motley lineup of items is guarded. Why boxes of benign alcohol swabs, hydrogen peroxide and urine-testing strips? How come the motion-sickness medicine Bonine is behind the counter but not its competitor Dramamine?

I wondered if the placement was designed to help deter theft -- statistics show baby formula, for instance, can be a tempting target. But I found it oh-so-curious that anyone would risk jail time for saline nasal gel.

In addition to being a subject of curiosity for consumers, nonprescription items that are held hostage behind pharmacy counters are hot topics lately in drugstore circles. The collection of items there reflects, in a big way, turmoil that is roiling the pharmacy profession.

There is, of course, the huge national, political, professional, women's rights and religious ruckus that Plan B has kicked up. Plan B is the "morning-after" contraceptive some pharmacists are refusing to stock or fill on religious or moral grounds. It is a massive subject in itself that I will flee here in favor of smaller and less-touchy ones such as . . .

Mucus. As anyone who recently has had a stuffy nose knows, most pharmacies in the Washington area and in more than 30 states have put nonprescription cold tablets containing pseudoephedrine (the active ingredient in nasal decongestants such as Sudafed, Tylenol Cold and Claritin D) behind the pharmacy counter. This is part of an effort to help law enforcement cut down on the manufacture of methamphetamines. Pseudoephedrine is a component of that illegal street drug.

Making customers ask for cold tablets is a good example of a decision that has plusses and minuses for drugstores and pharmacists, says Rob Eder, the editor of Drug Store News.

On one hand, the practice cuts down on theft. Eder says putting items behind a counter and making their purchase obligatory there helps with theft by putting an extra set of eyeballs on them.

On the other hand, the placement creates what retailers call a "barrier to purchase." You may find it embarrassing to ask for a sitz bath. Or there may be such a long line at the pharmacy that you just skip the stop and go home.

Obviously, if you leave without buying, the store loses money.

But who decides what goes there? Totally different items reside behind the counters at my local CVS drug store, Target and Giant. For example, I saw zinc oxide at Target but nowhere else.

Janet Engle says every store makes up its own list. Engle is a former president of the American Pharmacists Association and associate dean of the University of Illinois at Chicago College of Pharmacy.

However, she says chain drugstores often standardize their lists.

She also points out that some things go in and out of sequestration. When they were first introduced, teeth-whitening kits, for example, were guarded as zealously as Harry Potter books before their official release dates. Some stores put empty boxes on the main floor and the real thing behind the pharmacy or customer-service counter. Then the cost of the kits came down; and they're back on shelves, with stores relying on anti-theft tags.

And Engle says the box of glycerine suppositories I saw behind one counter was probably empty because they often require refrigeration.

Products are sometimes put both behind the counter and on self-service shelves as an aid to customers. For example, the wide array of specialized products for diabetics -- blood-glucose monitors, testing strips -- is commonly behind the pharmacy counter. As a result, seemingly innocuous alcohol swabs are there, too, because it is easier to hand them to a diabetic customer -- blood-glucose meters and other diabetic supplies are customarily behind the counter -- rather than say, "You need alcohol swabs for this; so don't forget, they're in aisle 3."

Charlene Fairfax, a registered pharmacist and clinical care coordinator for CVS's diabetes/asthma center at its store on Bladensburg Road, says diabetic supplies are a good example of why many pharmacists want a third class of drugs -- the other two being prescription and over-the-counter (ones that are self-serve) -- that would always be placed behind a counter.

Diabetic products are there because "there are so many options and it's often necessary for pharmacists to tutor patients on their use," Fairfax says.

Eder conducted a survey recently in Drug Store News asking whether member pharmacists and retailers supported creating a third category of drugs that would be nonprescription but doled out by pharmacists.

Eder reported that 67 percent of respondents wanted the new category. Thirty-three percent did not.

The numbers reflect what Fairfax says is a concern in the profession that consumers don't appreciate or make use of pharmacists' extensive training and ability to advise us.

As the world has changed, pharmacists have become easier to ignore, she points out. Among other things, the profession is anxiously eyeing the mounting tendency to order cut-rate drugs for chronic conditions through the mail. Kmart has installed an automatic prescription dispenser at its Penn Station store in New York City. The machine works much like an ATM machine, with PIN numbers and credit cards. Fairfax argues that advice given by pharmacists is crucial because too many people don't read instructions, dosage limits or other drug-usage materials. She says the one-on-one provided by pharmacists can circumvent some of the serious consequences of the improper use of drugs -- extending to whether you need a sinus tablet or another that targets one of the more than 100 rhinovirus subtypes.

But getting us cozy with our pharmacist isn't a simple proposition. There's a nationwide shortage of them -- at one point, there were some 6,000 vacancies among chain drugstores. Plus, at this point, they're giving their advice and time for free in the midst of busy workdays.

The industry is watching a provision in the Medicare Modernization Act that takes effect on Jan. 1. It mandates paying druggists in hospital or long-term health care pharmacies when they consult with Medicare patients who take multiple drugs for chronic illnesses. Could private health insurance companies eventually pay pharmacists for talking to us about our ailments?

Many pharmacy groups hope so, says Fairfax.

Thinking back, though, to my snail-like journey to the head of the pharmacy line the other day, I'm not so sure that I really want my pharmacist to be a people-person. I like the fact that he or she might take time to advise me about medications, but I don't like the idea of him doing it for everyone in line ahead of me.

Besides, illness can make people self-centered and chatty. Do pharmacists really want to listen to everybody's Uncle Charley go on and on and on about his upper respiratory tract and the color of his excretions?

Isn't this what bartenders are for?