Strictly speaking, the pharmacy can't assume that a spouse (or anyone) has been asked to pick up a script, and has every right to adhere to the letter of the law. Many don't because they are willing to take the risk in the name of good customer relations. I think that if I were a pharmacist, I would call the spouse and ask for verbal permission.
Yes, there are countless married people who don't want anyone at all to know what drug they have been prescribed.
There are also couples who have just broken up or even just had a fight - how is anyone expected to know who wants privacy or not?
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