What Do Automated Drug Kiosks Have to Offer?

For years I have heard people ask, why not a RedBox for pharmacy? And honestly, I wondered that too. I mean, I have seen small examples in different locations; my local hospital has a kiosk across from the outpatient hospital pharmacy, for after-hours operations. Some have settled at clinics, EDs, and other locales that get frequented enough to appear profitable.

One company, MedAvail, has been around for several years. It was being used in pilot centers, back in 2014, by Walgreens, and is currently available in several states.^1,2 It's quite a fascinating device in several respects, and if you ever wondered how these things work, I highly recommend watching the YouTube Video that demonstrates it.³ It's quite a good video, as it shows how it should work ideally, but the inner mechanics of the automation technology is rather good, and how to maintain its function (e.g., labels, medication refills) stand out as well, for those that are unfamiliar with the process.

Now, a provider cannot e-prescribe directly to a kiosk unit, but patients can refill a medication at the unit (after a transfer occurs). There are some limitations on what medications are stored in the unit. Based on what I can tell from looking at the inventory stored in them (via the inventory unit manager you can search online), it seems like leading antibiotics, NSAIDs, inhalers, and commonly used cardiac medications. Nothing controlled, which makes sense, as I don't think most people want to see these units broken apart as people try to get at what is inside. No suspensions or similar drugs are available, which also makes sense, as the units don't have the machinery to conduct such compounding features.

Ideally, these units make sense in areas with high traffic after hours and with no 24-hour pharmacies locally available. I would think close communication with local clinics or ERs would make sense to give providers an understanding of what medications they could readily prescribe from the units or a discussion of top choices to conversely supply based on provider preference.

It is a product that will likely find a niche in specific locations. Unless you make a building the size of one of these units that can dispense multiple medications at once, and supply teleservices all at once, I don't see these replacing pharmacies anytime soon. This is also alongside the other obvious issues with the management of controlled substances inventory and their dispensing, and medications that need to be mixed or compounded before being given to a patient.

Now, there is a company that supplies a similar service, but is nearly on the other side of the world. Right ePharmacy, is a new company focused on getting pharmaceutical care to patients in South Africa.⁴ This is an interesting company, as compared to other singular kiosks provided in the United States, like MedAvail; Right ePharmacy is the closest thing that I can imagine what an Amazon-meets-Pharmacy business model would look like.

Right ePharmacy provides several services that really push the roles of automation, and on-demand services for drugs. First, they have a Pharmacy Dispensing Unit (PDU), which essentially is a kiosk to dispense medicatiions. Next are Prescription Collection Units (PCU) which remind me of Amazon pickup units that have been in development in the United States. These essentially allow patients access to predispensed medication parcels in lockers that are unlocked when the right patient comes to pick them up. Both the PDU and PCU have a telemedicine service available for a remote pharmacist to talk to patients, and to provide information as needed.

Now, judging by the company's advertisement images, there seems to be a public health focus with their services. With HIV still being a large issue in Africa, supplying centers to dispense medications could be an exciting means of getting antivirals to the population, helping with access and improve adherence.

I am fairly interested to see how far these kiosks or drug ATMs start to take off. It's currently an attractive market in the pharmacy space. On the one hand, you have some pharmacy companies exploring same-day delivery services, mail-order companies won't be going away, and the possibiity of how Amazon would play into the space. For me, the concept of PDU and PCU from Right ePharmacy seem similar to other services that Amazon could provide or already provide. That does not necessarily mean its the only way to move forward, though at this time I am increasingly wondering what the next innovation will be in medication dispensing (regarding rapid services) or if we have plateaued for the interim period, based on current rules and regulations and technological means.

References

• MedAvail website. http://medavail.com/. Accessed April 6, 2018.
• Walgreens pharmacy kiosk. Walgreens website. https://www.walgreens.com/topic/promotion/walgreensrxkiosk.jsp. Accessed April 6, 2018.
• The MedAvail MedCenter (Pharmacy Kiosk). YouTube. https://www.youtube.com/watch?v=kwa-TdDfPSE. Accessed April 6, 2018.
• Right ePharmacy. Available from http://rightepharmacy.co.za/. Accessed April 6, 2018.