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Irene Nazarko, 58, a memaker in Secau, N.J., w calls herself a “spalic,” said during a contempo Wal-Mart airing that she already went to the abundance four times a anniversary afore she heard of the all-encomping biologic offer. “I get groceries, I get dairy, I get beard ucts, facial ucts, aloof about aggregate there,” she said.

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Altugh she has biologic allowance through her husband’s employer, Ms. Nazarko nonetheless ahead spent $40 in co-payments for a two-month aculation of the brand-name thyroid biologic Synthroid, which she purchased at a adjacency pharmacy.

To booty advantage of the Wal-Mart plan, Ms. Nazarko had her doctor about-face her to levothyroxine, a all-encomping version, which now costs her $8 for 60 pills, a two-month supply. The money she saves at the Wal-Mart pharmacy adverse will not leave the store, she said. “I’ll absorb the money on added spping.”

But for abounding of the about 80 percent of Americans w do accept biologic coverage, whether through Medicare, Medicaid or employer-sponsored bloom plans, a $4 decree for a month’s aculation of a all-encomping biologic may be alone hardly added attractive. An insured chump accommodating and able to about-face to a all-encomping ability do about as able-bodied at abounding approved drugstores.

“The boilerplate co-pay for these drugs is $5.37,” said Tmas M. Ryan, arch controlling of CVS, the big angis chain.

Mr. Ryan insists he has apparent little aftereffect on sales in his aliment back Wal-Mart appear the $4 affairs in September. He contends that best barter with allowance will abide loyal to adjacent pharmacies rather than accomplish a cruise to a big box abundance to save a few dollars on medicine.

Not everyone, tugh.

Before Wal-Mart’s drug-discount program, Patricia Symonette, a 54-year-old administrator for the Cleveland Munil Scol District in Ohio, would ample prescriptions for her bedmate and herself at a bounded CVS.

Ms. Symonette consistently takes a biologic for claret sugar, and she and her bedmate are on medications for aerial claret burden and clesterol. They accept biologic insurance, which requires alone a $10 co-payment for name-brand drugs and $5 for generics. But by switching to generics, they both can save money at Wal-Mart.

“I go there now aloof because of the pharmacy,” said Ms. Symonette, w was visiting from Ohio and had aloof best up some all-encomping decree algid anesthetic at the Secau Wal-Mart.

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But she actomed that she had already been a three-times-a-month Wal-Mart client for advantage and clothes. “W doesn’t boutique at Wal-Mart?” she asked. “You can’t exhausted their prices.”

The $4 drugs ability ignment best in alluring new Wal-Mart barter amid the 46.6 actor bodies in this country after bloom insurance.

“I was never a chump of Wal-Mart,” said Frank Ganci, 74, a retired absolute architect w lives in Ridgefield, N.J. He has no biologic insurance, admitting actuality acceptable for it beneath Medicare, because he considers the account premiums too high.

Mr. Ganci said he afresh paid $12 for a month’s aculation of three all-encomping drugs at the Wal-Mart in Secau — atenolol for a adulterated affection valve and two claret burden drugs, hydrochlorothiazide and lisinopril.

His drugs had amount him $110 at his bounded pharmacy aftermost month, he said. Added than bisected of that was spent on a name-brand drug, which his doctor switched to all-encomping atenolol so that he could buy it beneath the Wal-Mart program.

The $4 prescriptions accept angry him into a Wal-Mart spper, Mr. Ganci said. “If they don’t accomplish up the money on prescriptions, they’re activity to accomplish it up on my clothes and aliment purchases.”

Customers w absorb their pharmacy aculation abroad aural Wal-Mart are a urance that at the actual least, the company’s $4 all-encomping biologic affairs could be confined as a accident baton that stimulates added sales.

But Wal-Mart has insisted from the alpha that it will accomplish a aculation on the $4 drugs, which are about not the best avant-garde all-encomping subsutes for name-brand medications. The account of 331 drugs, for example, does not accommodate simvastatin, the all-encomping adaptation of Zocor, which is the arch addition to the accepted clesterol biologic Lipitor.

“It can alone be in our affairs if it is profitable,” said Bill Simon, Wal-Mart’s controlling in allegation of the biologic program. “That’s why we do not accept the newer, added big-ticket conversions” — all-encomping versions of name-brand drugs.

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Some biologic industry ysts say, wever, that alike by attached the affairs to the cheapest generics, Wal-Mart ability be able to acknowledge the all-embracing affairs isting alone by overextension the costs able-bodied above its pharmacy ledger.

Some generics can absolutely be purchased broad by pharmacies for beneath than $4 for a 30-day supply, said Ed Heckman, a pharmacy adviser in Stoughton, Wis. For example, a month’s aculation of fluoxetine, the all-encomping adaptation of the antidepressant Prozac, can be acquired for 75 cents, he said. And warfarin, the all-encomping agnate of the claret thinner Coumadin, costs about $3.60.

But added costs, including abundance aerial and pharmacists’ paychecks, can add as abundant as $15 to the amount of dispensing a prescription, Mr. Heckman said. So affairs drugs at $4 ability be able-bodied beneath amount for abounding pharmacies.

Wal-Mart declines to accommodate abundant abstracts about the program, which began Sept. 22 in Tampa, Fla., and has bound advance to added than 3,800 Wal-Mart and Sam’s Club pharmacies in 49 states. The barring is North Dakota, breadth Wal-Mart says it is not actomed to accomplish pharmacies.

Wal-Mart said beforehand this anniversary that in nine added states — including California, Minnesota and Pennsylvania — it had taken 55 drugs off the $4 account and was charging $9 for them in acquiescence to accompaniment regulations that prohibit apprait beneath amount if accomplishing so could drive aggressive aliment out of business.

“These states accept bargain laws, and we capital to be in compliance,” said David Tovar, a Wal-Mart spokesman. While the laws vary, Mr. Tovar said, the $9 amount seemed to accede with them all.

Target, which afresh absitively to bout the $4 affairs at 1,287 pharmacies in 47 states, has beneath to altercate whether it can about-face a aculation on the all-encomping drugs in its plan.

“I cannot allege to the banking aspects ociated with this program, as we accede this to be arcane and proprietary information,” said Paula Trnton-Greear, a Ambition spokeswoman.

Wal-Mart, crumbling to adduce all-embracing sales abstracts for the program, said that in the aboriginal seven weeks it had abounding 2.1 actor added prescriptions of all types — all-encomping and name-brand — compared with prescriptions in the aforementioned aliment a year ago.

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Tse numbers would announce that in the aboriginal activity at least, Wal-Mart’s $4 prescriptions are not accepting a huge appulse on all-embracing sales of all-encomping drugs in this country. Nationwide, abounding of the best accepted all-encomping drugs are anniversary igned added than a actor times in a distinct week, according to Wolters Kluwer Health, a biologic abstracts company.

In the Tampa area, some absolute druggists and a big biologic banker say that they accept not noticed abundant aftereffect on their businesses back the September rollout.

“I don’t apperceive of any prescriptions transferred to Wal-Mart or patients w went to Wal-Mart,” said Bob Bobo, buyer of the Davis Islands Pharmacy in Tampa.

Carmen Cartaya, the co-owner of addition Tampa drugstore, David’s Pharmacy, had a agnate comment. “They are not demography any business abroad from us,” Ms. Cartaya said. The drugs in question, she said, are already “very, actual inexpensive.”

AmerisourceBergen, a ample biologic wlesaler, has not apparent “any allusive about-face in the generics bazaar in Tampa or beyond Florida” back September, said Michael N. Kilpatric, a carnality admiral of the company.

Richard T. Evans, a biologic industry yst at Sanford C. Bernstein & Company, said that for Wal-Mart, which has been a common ambition of activity unions for its pay and bloom allowances policies, affairs $4 drugs “makes added faculty as a political air cover” than “as a retail strategy.”

If so, the aggregation may appee to accede enlisting chump converts like Mr. Ganci, the uninsured retiree, for a public-relations campaign.

“I couldn’t be added ecstatic,” Mr. Ganci said of his $12 bag of drugs. “I accord Wal-Mart a lot of acclaim for accomplishing this. Why can’t added drugstores do this? Why can’t our own government do this?”

An commodity in Business Day on Thursday about Wal-Mart’s auction of some all-encomping drugs for $4 a prescription, misidentified a name-brand biologic that a patient, Frank Ganci, took afore switching to a all-encomping alternative. The biologic was Diovan, for aerial claret burden — not Ativan, which is igned for anxiety. The commodity additionally misidentified the gender of a angis owner. Carmen Cartaya is a woman.

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