If you've never come face-to-face with the pharmacist at your local drug store, get ready for a big surprise.

Beginning Jan. 1, pharmacists throughout the state will emerge from behind the counter to assume a role that could well change the face of pharmacy services and greatly influence how Californians take their medicines.

A state Board of Pharmacy regulation will require pharmacists to consult with every patient who receives a new prescription or a refill that has changed.

The regulation is a bold tactic designed to address the widely acknowledged problem of patient misuse of prescription drugs, which is thought to cost billions of dollars annually in preventable side effects, hospitalizations and prolonged illness. Reaction from health-care providers has, however, been mixed.

"We've got pharmacists on both sides of the issue," says Giny Herold, assistant executive officer at the state Board of Pharmacy. "We're looking at a real change in pharmacy services in the state."

Opponents question whether pharmacies are set up to provide consultations. Some of the specific concerns include:

* Confidentiality: Will the pharmacist and patient have a place to confer if privacy is desired?

* Will customers end up waiting in long lines to receive prescriptions if the pharmacist is tied up in long consultations?

* Will the pharmacist have enough information about the patient and the other medications that patient might be taking in order to provide an accurate consultation?

* Will this expansion of pharmacy services cause economic hardship for facilities already hard hit by medical cost-cutting, like public hospitals already suffering from serious staffing shortages?

* Will the state be able to enforce the regulation and measure its effectiveness?

Many of these concerns are dwarfed by the larger problem that the regulation is attempting to address, Herold says.

"There are a number of reports that indicate substantial medical costs due to mismanagement of prescription drug use," she says. "And there are an incredible number of hospitalizations relating to the lack of knowledge people have about taking multiple prescriptions."

According to the National Council on Patient Information and Education, a consumer education group on prescription drug issues, up to half of the 1.6 billion prescriptions dispensed annually in the United States are used incorrectly.