A dispute between Walgreens and a contractor has left millions of the drugstore's customers dealing with the hassles of finding new pharmacists.
Long lines, communication problems and a risk for some patients have developed as Walgreens' competitors rush to lure prescription medicine customers cut loose as of Jan. 1.
Rival pharmacies such as CVS, Safeway and Rite Aid benefited significantly from the rift. Switching takes only a few minutes, they are telling customers, and that has been true for many.
But finding a new pharmacy can raise a significant hurdle for low-income people who may lack cars or credit cards or Internet access, said Dr. Edward Machtinger, director of the women's HIV program at UC San Francisco.
Machtinger himself had to switch pharmacies. He can no longer walk to the Walgreens three blocks from his home.
"That's an incredible inconvenience and an incredible disruption to my routine," he said. But patients who lack his resources "are often not able to overcome that challenge."
The falling out occurred between Walgreens and Express Scripts, a pharmacy benefit manager that in 2010 did $44 billion worth of business. Health insurers and employers hire such firms to lower costs by negotiating discounts with pharmacies.
But last year, the two could not agree on a contract.
The result: On Jan. 1, millions of Walgreens customers whose insurers are affiliated with Express Scripts had to switch pharmacies.
Among those affected were members of certain Anthem Blue Cross plans, the TRICARE program for military members, and some Medi-Cal managed plans.
The rush of new business has led to delays at pharmacies eyeing the new business. Safeway is "definitely overloaded right now," said a San Francisco physician assistant. The grocery store chain has heavily advertised its pharmacy services.
One day, 10 people were lined up at the Safeway pharmacy and she had to wait 45 minutes, said Nora Branning. She misses the Walgreens pharmacist who knew her and her prescriptions.
People like her made up a chunk of Walgreens' business. In 2011, the nation's largest drugstore chain filled 88 million prescriptions for Express Scripts customers, worth about $5.3 billion.
Walgreens last month reported an 8.6 percent drop in filled prescriptions compared to January 2011. That was due to losing Express Scripts customers and a mild flu season, said spokesman Jim Cohn.
Machtinger of UCSF said many of his HIV-positive patients have multiple medications, some of which aren't stocked at certain pharmacies or require pre-authorization. Their old pharmacists helped them through challenges.
But now, he said, their routines have been upended. Some stopped taking their drugs while figuring out how to switch pharmacies.
"Suffice it to say that adding a big new roadblock and challenge can be devastating to your health," Machtinger said.
San Francisco resident Brett Brockschmidt, who has AIDS, takes 25 different medications. He is upset with Anthem Blue Cross for not notifying him about the Walgreens-Express Scripts split until Jan. 2, too late to enroll in a plan that would let him stay with Walgreens.
He switched to CVS, but sometimes pharmacists can't find his fax from the day before or have to hunt down his medications.
He disagrees with those who say switching is easy.
"I wasted at least 30 hours of my life trying to do this and it's not been particularly fun," he said. "It's not really (CVS's) fault. It's just they're swamped."
Not surprisingly, Walgreens and Express Scripts differ on why they broke up.
Express Scripts claims Walgreens wanted prices that would have risen to as much as 20 percent more than at other pharmacies.
Walgreens spokesman Cohn said his company offered to keep drug rates at current levels but Express Scripts wanted to cut them to below the industry average.
Express Scripts says the split was not a significant problem. "Overwhelmingly, our clients and members have moved on to other pharmacies ... with minimal disruption," said spokesman Brian Henry.
CVS, meanwhile, believes it can capture 30 percent of the displaced Walgreens customers, said Carolyn Castel, vice president of corporate communications.
"We're seeing a significant number of transfers," she said. "It's really more than we anticipated."
CVS has beefed up staffing, Castel said. "We want those customers to have a very good experience."
Anne Morse, who runs a gardening business in San Francisco, said it was easy to switch to Safeway, but she, too, said it seems understaffed. One day, a prescription she ordered the day before wasn't ready so they filled it on the spot.
"Meanwhile there was a line building behind me. So they're a little disorganized."
Safeway spokeswoman Teena Massingill said that since the first couple of weeks, Safeway has added employees, extended hours and made technology changes to help the new customers.
Walgreens is looking forward to recovery. By the end of fiscal year 2012, it expects to have 97 to 99 percent of its 2011 prescription volume.
Sandy Kleffman covers health. Contact her at 925-943-8249. Follow her at Twitter.com/skleffman.