In the wake of the news that Amazon had bought online pharmaceutical retailer PillPack, Employee Benefit Adviser reached out to industry experts for their analysis. A pharmacist with more than 25 years of experience, Trista Collins shares her thoughts on why convenience may overtake a beneficial relationship with a concerned and knowledgeable medication expert.

I am familiar with the Pill Pack model, but I saw it presented along with a robotic dispensing device that “watches” the patient take their meds for adherence purposes. This was geared to an elderly population that needed closer follow-up.

The elderly are actually a population that I think could really benefit from this service. They are typically home-bound, on a lot of various meds/OTCs, and need assistance to sort and manage them to ensure they are taking them properly. That is something that is an ‘a-la-carte’ service available in assisted living centers and I think it is quite helpful. The drawback is how the elderly would interface with the app or the technology portion, as they are more accustomed to the face-to-face interaction with the pharmacist at the retail stores, which is the best part of retail pharmacy — getting to know your patients.

Bloomberg

As for how it is going to affect the brick and mortar chains — which leave a lot to be desired — I hope it will spur them on to innovation. Personally, I often have long wait times and don’t even get counseled on new medications, but I understand what they have to do so I don’t complain. I have been a pharmacist for 26 years, and did my share of retail pharmacy working behind the counter. Though we did a better job than most, slower store volume allowed for better customer service. When I was in a very busy store, the environment can best be described as extreme. On the one hand there are customers that don’t feel good and just want their meds in a hurry. On the other side of the counter is the staff who is under a constant barrage of questions and phone calls, working as fast as they can — all the while with a zero tolerance for error.

By nature it is a contentious environment. I’m sure everyone would welcome change.

I would think the idea would be popular and that more people would like to get their meds delivered, as I have seen more people getting even their groceries delivered. However, my concern would be that they would miss the opportunity to speak with a pharmacist about potential problems they may be having with their meds. Also, face-to-face interaction gives the pharmacist a chance to pick up on non-verbal clues that the patient may not communicate (e.g. tardive dyskinesia or lip smacking as a side effect from a drug). I noticed this with a patient and she thought her lips were just dry so she was licking them all the time. Since I could tell it was a drug-related side effect, I spoke to the physician and we were able to get her off the med.

Good pharmacists can tell a lot when counseling patients about meds, especially when they are on addictive medications. They can read the patient and act as their advocate with the physician. Patients tell us things you wouldn’t believe — a lot more than we sometimes want to know — but it is all helpful in understanding who they are and where they are at in their treatment. Though those days behind the counter were long and difficult, the times I connected with patients to improve their lives made it worthwhile. I am confident my peers would agree a pack of pills cannot replace our knowledge base or the care and concern we have for our patients.

Can an algo replace a human pharmacist?

As for what all is involved in Amazon’s fulfillment of a prescription, there are many pieces to that puzzle still missing for me. Other than the pack coming monthly with a roll of nice little tear off packages pre-printed with the time of day for that assortment/dose of pills to be taken, there are other things they should be doing.

What happens if the patient forgets to take them? If they have inhalers or topicals, are those just sent separately with regular RX labels? Are packaged pills (like birth control pills) sent in their original pill containers or are they punched out and sent in the little pack? Are all OTCs sent inside the pack as well so the patient knows when to take them (vitamins, cold products, etc?) I would want to understand what Amazon is going to do about having a patient link to a pharmacist if they have questions about their meds or need counseling on a new medication as many states require counseling on a new med.

Are they going to play the entire role of the pharmacy, and if so, they need to do more than just fill scripts. We pharmacists do much more than that ­— we didn’t go to school for 6+ years just to count pills.

I would also want to know that a pharmacist (not a technician) is checking your order for accuracy, as in the right drug for the right person at the right dose. Are they able to fill controlled substances in the same pack and if so, what limitations are they putting on the opioids? What about all the drug information — how does that get sent — in a separate envelope? Are they able to have a pharmacist call you and your physician with questions or to renew your meds? What about any insurance limitations such as Prior authorizations? How is your copay or rebates to your plan affected? How many pharmacists do they have on ‘staff’ and are they available 24/7?

Pharmacists continue to be one of the most trusted professions in the country. However, that doesn’t mean you should blindly take what is given to you. Patients should pay attention to what their prescription says — or even take a picture of it/ask the doctor or nurse to read it to them — so patients can verify that what they received at the pharmacy is correct. People should also know what their pills look like, so if they get different ones, they can ask the pharmacy why.

Be informed and know what to expect from your medication. Write down on a calendar any weird side effects or problems you notice, especially when you first start taking a new medication, and talk to your pharmacist about it right away. Be an informed consumer and communicate your questions and problems so we can better assist you.

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