When Marie Knickrehm of Salt Lake City first heard of Wal-Mart's $4 generic prescriptions drug plan, she thought it was a great idea.

But after reviewing its current list of 331 generics drugs -- released at a Sam's Club in Salt Lake City as part of the discount retailer's kick-off of its $4 plan in Utah and 10 other states on Thursday -- Knickrehm has mixed feelings.

"My husband and I are on anti-inflammatories for back pain. But the prescription drug we take isn't on this list," she said. "Still, the list looks like it'll be good for the elderly and those who need antidepressants, cholesterol and diabetes medication. I'll probably be getting antibiotics and cholesterol drugs for my parents here."

On Thursday, Wal-Mart expanded its $4 offer for prescription drugs to Utah and other states several months ahead of schedule. The program -- which is expected to make generic prescriptions more affordable for an estimated 380,000 uninsured Utahns -- is now available at 40 of Wal-Mart's pharmacies in Utah including those in Orem, American Fork, Springville, Lindon and Payson, and a Sam's Club in Provo.

First launched in Tampa, Fla., on Sept. 21, Wal-Mart's $4 drug plan is available at 3,009 stores in 38 states, now including Utah, Idaho, Kentucky, Maine, Massachusetts, Nebraska, Oklahoma, Rhode Island, South Carolina, Washington and West Virginia. The program includes 331 generic prescriptions available for up to a 30-day supply.

The discount retailer, citing enthusiastic approval from millions of seniors, working families and uninsured customers since the program's launch, fast-tracked its plan to hit all 50 states by as early as January. That's well ahead of its initial plans to launch the discount program outside Florida in 2007.

To date, 2.1 million more new prescriptions have been filled at Wal-Mart and Sam's Club pharmacies since the drug program was launched in 27 states in September.

Plan advantages

Wal-Mart, facing mounting pressure from union groups over its labor practices, including health insurance coverage, says the program will not only lower health care costs, but also help ease the problems faced by some seniors who have fallen into the so-called "doughnut hole" of Medicare's Part D drug benefit. That coverage gap forces them to pay 100 percent of their prescription drug costs once they reach between $2,250 and $5,100 worth of medications in a year. There are 192,000 Medicare beneficiaries in Utah.

"Health insurance premiums are up 7.7 percent this year, more than twice the rate of inflation. More than 14 percent of Utahns don't have health insurance," said Gerry Hassell, pharmacy district manager for Wal-Mart.

That's what justifies the thought process for this program, said Wal-Mart President and CEO Lee Scott.

"No one should be denied access to the medications they need, and this program is a big step in moving our customers and communities toward access to affordable medicines in Utah," Scott said.

For Don Dyer, a 60-year-old retiree from Salt Lake City and a Sam's Club regular provided by Wal-Mart's media relations team, says he sees Wal-Mart's program helping many low-income individuals and families.

"I saved $500 a month on medications at Sam's Club's pharmacy. Both my wife and I get about nine prescriptions for pain pills, muscle relaxants, blood thinners, diabetes and depression," Dyer said. "We used to get our prescriptions at Rite Aid, but it was costing us a lot."

Criticism from consumer advocates

But critics, including union organizers and the National Community Pharmacists Association, which represents 24,000 independent pharmacies, have called the discounts a publicity stunt aimed at driving more foot traffic into Wal-Mart and Sam's Club stores. They also say the drug program only covers only a fraction of the 11,000 generic prescription drugs approved by the Food and Drug Administration.

"If you look at the list of medications they are offering for $4, it represents about 1 percent of the total number of drugs available," said Bruce Roberts, the pharmacist association's executive vice president and CEO.

"The question people should be asking Wal-Mart is, 'What will you be charging for the other 99 percent of the medications that people needfi' "

And while the Wal-Mart program claims to offer more than 300 medicines, its list actually includes fewer than 150 different drugs, the association said. For example, 15 different versions of the antibiotic amoxicillin are included on the list.

Karianne Fallow, Wal-Mart's senior manager of public affairs, disagreed. "Generic medicines generally cost between 30 percent and 60 percent less than equivalent brand-name products, but many of them work just as well as brand name drugs. Our list includes some of the most common therapeutic classes, like drugs for diabetes, cardiovascular heart problems, asthma, colds, viruses and infections."

She said Wal-Mart intends to further expand the list of generic drugs on the list, but wasn't able to specify how many more will be added.

Utah Senate President John Valentine, R-Orem, speaking at Thursday's roll-out of the program, challenged more retailers to match Wal-Mart's $4 generics plan.

"Two months ago, when I first heard about the $4 plan in Florida, I called Wal-Mart's headquarters and they flew their people out to talk to me about responding to the health care needs of Utahns," Valentine said.

"Many have criticized this program as an effort to attract customers to their stores. But this program really helps make prescriptions more affordable for more Utahns."

Pharmacy businesses' reaction

Meanwhile, Wal-Mart's generics plan has forced competitors, including Target Corp. and Costco, to come up with similar programs. Kmart rolled out a nationwide generic prescription plan in May that offers a 90-day supply of drugs for $15 at 1,100 Kmart pharmacies nationwide.

"While Wal-Mart's program appears to be a cost-saver at first glance, Kmart's 90-day program is a better value and time saver for customers, allowing them to return to the store every three months instead of every 30 days to refill their prescriptions," said Mark Doerr, vice president of Kmart Pharmacy.

"The $15 cost spread over three-months ultimately means that customers are paying $5 a month for refills, but saving money on gas and valuable time associated with frequent trips to the pharmacy."

Wal-Mart's list of 331 generic drugs can be found at www.heraldextra.com/druglist.

This story appeared in The Daily Herald on page A1.

List of generic drugs available