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If you belong to an HMO like Kaiser, then you're probably reeling from this year's steep hike in drug "co-pays"--the amount of money you must contribute for your prescriptions. Still, if your health insurance has a co-pay at all, you should consider yourself lucky.

Noe Valley residents who have to pay cash for their prescriptions say drugstore prices are skyrocketing and that it's no surprise people are flocking to the Internet to get cheaper medications from Canada.

"It seems as if every prescription we get costs between sixty and eighty dollars," says a Noe Valley father of two, whose prescription coverage disappeared along with his high-tech job last year. Though he was given the chance to continue his family's coverage through the COBRA program, he declined when he found out the price tag was $800 a month. Instead, he opted for a plan with a $180 monthly premium that has a high deductible and no drug coverage.

While the cost of his prescription drugs counts towards his $4,800 annual deductible, he says he has been "bowled over" by the cash prices for his family's medicines. "Even the generics can run you fifty bucks. I don't understand why they are so expensive."

The high prices are a common topic in Noe Valley, where a large pool of self-employed and unemployed people choose to pay cash for their prescriptions, rather than fork over hefty monthly premiums for drug coverage. Some, in the habit of shopping around to find the best deal, say that prices can vary widely among neighborhood drugstores.

So Who's the Cheapest?

In April, the Voice did its own informal survey of local pharmacies to determine if there is one low-cost leader (see sidebar). We found that between the two neighborhood pharmacies, Rite Aid on 24th Street and Walgreen's at 24th and Castro, one is often significantly less expensive than the other, depending on the drug you are purchasing.

The problem is, neither appears to be less expensive across the board. Consider this: While Walgreen's price for 30 250-milligram tablets of the antibiotic Amoxicillin is nearly $6 less than Rite Aid's, Walgreen's price for 30 100-milligram tablets of the antidepressant Zoloft is $10 more than the Rite Aid price.

Walgreen's spokesman Michael Polzin says the price differences are the result of the marketplace at work. "Different stores have different costs of doing business," he says.

In an effort to find the low-cost leader, we compared Walgreen's and Rite Aid's prices with those of Costco and some online pharmacies. We found that prices at Walgreens.com run 10 to 30 percent lower than those at our local Walgreen's store. Savings at Drugstore.com, which is affiliated with Rite Aid, are in a similar range.

Obviously, if you need a medication right away, ordering it online and waiting several days for delivery is not an option. But for "maintenance" drugs such as birth control or allergy pills, which need to be taken regularly, online pharmacies can offer significant savings. Not only are the prices lower in general, but cash customers with prescriptions for several refills can take advantage of quantity discounts.

For example, Drugstore.com's price for 30 five-milligram Clarinex tablets (an allergy drug) is $66.99, or $2.23 per tablet. Buy 90 tablets and the price drops to $2.05 per tablet.

The ability to purchase all refills at once is probably the only advantage the cash customer enjoys. That's because HMOs and other health insurance providers often don't allow members to refill a prescription until they've used up 25 days of a 30-day supply.

Of the options we explored, Costco consistently offers the lowest prices for prescriptions. As with a bricks-and-mortar pharmacy, you can get your prescriptions filled within 30 minutes to an hour. The downside? You have to leave Noe Valley (Costco is at 10th and Harrison downtown). And navigating the crowded Costco parking lot and warehouse is not nearly as pleasant as a walk down 24th Street or a personal chat with your neighborhood pharmacist.

Crosschecking Advised

Not surprisingly, you can also order cheaper prescriptions at Costco.com, but the online database is not linked to the one used by the physical store. This is an important distinction, as the ability to crosscheck an individual's various prescriptions can prevent potentially dangerous drug interactions.

Buying all of your prescriptions from one pharmacy is one way to ensure that drugs are being crosschecked. But consumers who choose to shop around for the best prices need to take extra care to ensure that crosschecking occurs with each new prescription. You can do this by giving a list of your existing medications to the pharmacist each time you fill a new prescription. Or you can log onto the Internet and key in your prescriptions. All of the major online pharmacies, including Costco.com, Drugstore.com, and Walgreens.com, offer easy-to-use drug-interaction checkers that will flag any combinations that might cause harm.

Pricing aside, one advantage that Walgreen's enjoys over its competitors is that it is the only national chain that has its online and retail pharmacies linked.

"You can get a prescription filled for the first time at a retail store," says Polzin, "and then transfer the prescription to Walgreens.com and get your refills online for less." You can also order your prescriptions online and pick them up at your neighborhood Walgreen's, he adds, but then the typically higher retail store price, not the online price, applies.

At either of the local drugstores, Walgreen's or Rite Aid, customers are welcome to call the pharmacies to check a price before filling a prescription. The number is 826-8533 at Walgreen's, 1333 Castro Street; and 648-8662 at Rite Aid, 4045 24th Street. h

Note: Repeated calls to Rite Aid Corporate Communications for comment went unreturned.

SURVEY OF PRESCRIPTION DRUG PRICES ­ 4/18/03

Medication	Dosage	Quantity	Walgreens.com	Walgreens (24th/Castro)	Rite Aid (24th Street)	Costco	Drugstore.com
Amoxicillin (antibiotic)	250 mg chewable tablets	30	$12.99	$14.09	$19.99	$10.99	unavailable
Ortho Tri-Cyclen (birth control)	tablets	28	$34.99	$34.99	$37.99	$31.69	$32.63
Clarinex (allergy medication)	5 mg tablets	30	$70.99	$80.59	$79.99	$61.89	$66.99
Zyrtec (allergy medication)	1 mL syrup	120 mL	$31.99	$43.69	$41.99	$31.99	unavailable
Zoloft (antidepressant)	100 mg tablets	30	$70.99	$92.29	$81.99	$71.37	$70.99

An April price check on five commonly prescribed drugs yielded no consistently cheaper option in the local drugstore derby. But if your budget requires you pay rock-bottom, go to Costco.