PillPack by Amazon Pharmacy: The healthcare disruptor we’ve been waiting for.
This post was co-authored by Timothy Dy Aungst, PharmD, a digital health expert who blogs regularly at the The Digital Apothecary.
Alexa, what’s my last blood sugar reading?
Your last blood sugar reading form 38 minutes ago was 145 mg/dL. Your pharmacist has adjusted your next pre-meal insulin dose to 8 units based on the diet ordered through Whole Foods. I also noticed you’ve been coughing and it seems like your enalapril may be the cause. Would you like your pharmacist to review alternative medications like losartan?
That’s the future of healthcare. It seems far-fetched and decades in the future. But the technology industry moves at a lightning pace. Consider the iPhone. An indispensable technology in today’s modern life that was originally launched a mere 12 years ago. At the time its main competitor was the Blackberry and the Motorola Razr. Today Blackberry and the Razr are essentially non-existent. Even the iPhone 1 is inoperable on today’s OS. With 85% of Prime users willing to use an Amazon Pharmacy service, in 10 years Amazon has the potential to fundamentally transform healthcare as we know it, including disrupting the drug-supply chain and novel technology integrations.
PillPack by Amazon Pharmacy is a new entity in the world of healthcare. When acquired by Amazon for $735 million dollars in 2018 it marked the entry of the tech giant to the world of pharmacy. Licensed in every state (except Hawaii), PillPack is an online pharmacy that delivers medications directly to patients in convenient packaging. Whether this new player can actually fix the inefficiencies in medication therapy is not known.
What Amazon does well it disrupts industries, and healthcare is primed for a disruptor. We have been advocating for value-based and patient-centered care, and that’s exactly what Amazon has made billions of dollars doing on the consumer front. By creating a patient experience for an unmet need that is convenient, reliably delivered and affordable, the patients will become loyal to Amazon. I’m hopeful that the Amazon-JPMorgan-Berkshire Hathaway partnership that intends on disrupting healthcare as we know it will succeed.
Obstacles, not barriers
Obstacles like HIPPA and PBMs are solvable problems for Amazon. When considering up to 25% of the $900 BILLION dollar pharmaceutical market pays cash for medication, Amazon has the leverage to become a huge disruptor. These cash payers aren’t just uninsured patients. Think about how patients with high deductible plans or insured patients before meeting their deductible could benefit from an alternative player competing for their business.
By taking such control of the industry, creating shifts in existing PBM policy will become nothing but small hurdles. Amazon may even be looking to become a PBM creating a tectonic shift, again putting more ownership of healthcare in the hands of the patients themselves. With such a big player, Amazon could improve transparency by allowing patients to view multiple products, price and “reviews.” When it comes to HIPPA, well, Alexa is already HIPPA compliant. Remember that Seinfeld episode where Elaine keeps trying to get ahold of her own medical record? Amazon Pharmacy just handed it over. However, Amazon will have to make sure it navigates an area that digital users are increasingly being wary of regarding personal information, such as the Facebook and Cambridge-Analytical debacle last year, and Google and Ascension Health medical information sharing concerns. This can be seen with recent news where Amazon is now working with the NHS which has caused major concerns for stakeholders.
Novartis-Amazon partnership is a potential solution to becoming a PBM that isn’t on the table for Amazon. They’ll simply sidestep the PBM process and offer medications directly from the manufacturer (or some similar relationship). There are other serendipitous benefits to such a relationship. Gaining from Amazon’s experience with manufacturing and distribution, drug shortages could be history. At the very least, the total cost of drugs could be brought down by improving manufacturing efficiencies and decreasing distribution costs.
Yes, PillPack is an online mail-order pharmacy (for now), and I (and likely you) are inpatient pharmacists. So why is this relevant? While the implications for the delivery of healthcare to patients are tremendous, it’s the fundamental shift in solving a problem that was thought to be unsolvable: healthcare problems are just a reality of the industry.
Polypharmacy, transitions of care, and medication compliance. As pharmacists, these are the three large obstacles we face in improving the health of our patients. Reducing unnecessary medications, optimizing drug therapy and ensuring patients actually take the drugs appropriately all while ensuring seamless transitions between care settings is like spinning plates. As soon as one gets going, the others start to wobble uncontrollably. Exceptional individual pharmacists help manage these problems, but a new opportunity to improve this care is at our doorstep.
The problems of complexity in disconnected elements of healthcare among prescribers, insurance companies, pharmacists, and medical records have been regarded as inherent bugs of the system. Elements that are to be accounted for, but remain largely unsolvable. Amazon is simply doing what we have been preaching: establishing patient-centered care. While putting the patient not only in control of their own healthcare but also at the center of the healthcare industry, the interface with that industry shifts to emphasize a better experience for patients.
Mitigating this concern, and providing an advanced and modern record (PharmacyOS), patients can ensure a complete and accurate medication record will travel with them through the healthcare system. That patient-centered care interaction is, of course, the ultimate goal of any transitional program. But taking that to another level, having real-time feedback and answers by leveraging existing Amazon platforms, pharmacists can impact patient care.
Consider the patient that gets discharged from the ED on a new DOAC (say apixaban) for DVT. They have a question about whether to take it with or without food. “Alexa, can I take my Eliquis with before dinner?” From the backend, we could be alerted that the patient had a relevant question, reach out and follow up with the patient. Patient reminders, interesting facts/trivia, counseling pointers can all be integrated into automated prompts from Alexa. On our end, we would have transparent pricing to know whether this patient will be able to afford the drug. If we needed to switch to use warfarin for whatever reason, we would improve care with INR monitoring/adjustment monitoring via Alexa with the patient interface.
An obvious threat to the profession
Of course, Amazon will not employ the same number of pharmacists that currently work in the retail setting, or in ways that have been discussed. It could be completely possible that Amazon chooses just to employ pharmacists to verify prescriptions in remote verification centers. However, this is not an Amazon problem. It’s a pharmacy problem. We have not positioned ourselves as a profession to be stakeholders in the future of healthcare. While emphasizing clinical activities is critical to our growth, we have forgotten the fundamental responsibility of us: medication therapy. Specifically owning all aspects of medication therapy, from clinical drug therapy management to the non-exciting operational and dispensing roles. It appears that any role we may have had in the future regarding this is gone.
The above roles I mentioned are centered around clinical pharmaceutical patient care. That shouldn’t change as a centerpiece. However, we have ignored the drug delivery aspect of pharmaceutical care for the sake of clinical advancement. As a consequence, we have been largely left out professionally in this new landscape. What we do now will define the fate of all pharmacists. Do we acknowledge this shift in healthcare and begin to prepare to meet its demands? Or do we continue to hedge and believe these are just inherent bugs in the system that will always be in place?
I leave that decision to you.
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