Prescription drugs at a 20 percent discount, throughout Tuolumne County, with no enrollment fees or strings attached?

The plan presented to the Board of Supervisors last week, indeed, sounded too good to be true. That's why the board was right to take a deep breath and a step back before pulling the trigger.

Before supervisors was the National Association of Counties' drug discount card program. NACo, a huge lobbying organization representing the interests of nearly 3,000 counties in all 50 states, negotiated the card deal with Caremark Rx, Inc., a major pharmaceutical services firm.

Under the NACo arrangement, Caremark negotiates with pharmacies to offer discounts on purchases not covered by buyers' insurance. Savings vary depending on the drug purchased, but average about 20 percent. Any loss at drug stores, the firm says, will be made up by new card-carrying customers that shop at member pharmacies.

Sound good so far?

Dr. Todd Stolp, the county health officer, recommended that supervisors sign up for the deal. But he conceded that drawbacks come with any plan "served on a silver platter."

In this case, pharmacies themselves are on the hook for the discounts. Chain drugs stores like Wal-Mart, Rite Aid or Longs buy in bulk, sell high volumes and can more readily handle the losses. But this is not true for independent local pharmacies.

"I get no check from the insurance company, I get no check from the county," said John Williams, whose Bob' Greenley Pharmacy is one of four independent drug stores operating in the county. "Basically I just give the prescription away at less than my retail price."

Also taken off the top, says NACo, is "a small fee" pharmacies pay to Caremark.

"There's something I don't like about this, but I'm not sure what it is," said Supervisor Mark Thornton, asking the county staff to look into the experiences of other counties in the program.

"To make an intelligent decision, we need more than we have here," agreed Supervisor Dick Pland.

The board then made an intelligent decision, delaying a commitment to the NACo plan. Among issues members should consider before making a decision:

? Who will benefit? Stolp said between 1,500 and 1,600 county residents are without adequate prescription drug insurance and could benefit from the plan, but he estimated that only 300 or so would actually use it.

? Are there other programs that might help the uninsured buy drugs? The board asked Stolp and Cori Ashton, a Human Services Department analyst, to research the question. Any existing programs, added Supervisor Teri Murrison, should be publicized before the county signs up for a new one.

? Does the program work elsewhere? According to NACo, its three-year-old program has been adopted by more than 900 counties nationwide and has thus far saved consumers about $60 million. The Human Services staff has checked with eight of nine counties in the program of a total of 58 counties in California, and reported finding no problems, but low participation.

? What are the motives of Caremark, a multi-billion dollar company that ranks 60th in the Fortune 500? The firm is obviously in the NACo deal to make a profit and its profit-making endeavors have led it into trouble in the past. Last month the firm agreed to pay $41 million to settle a multi-state lawsuit charging that it engaged in deceptive businesses practices by encouraging doctors to switch patients to different brand-name medications.

? And, perhaps most significantly, is it worth hurting independent local drug stores already dealing with hard economic times by adopting a program that will likely benefit a very small number of Tuolumne County's residents?