I’ve been a PillPack customer for years and love the service.
If you take multiple medicines, and/or have a complex medication schedule, it’s super convenient. It self audits whether you took your meds already and avoids spending a lot of time sorting pills into organizers.
It’s also really convenient for travel; just tear off the packets for the time you’ll be away.
Even the stingy insurances in two European countries I checked tend to pay for a service it if you're taking 3+ medicines, suggesting that it's cheaper in the long term for them, either by reducing cost from waste, cost from classic pharmacies, or by improving outcomes in ways that result in less treatment (or the company running it managed to convince the regulator to make it covered by mandatory insurance because it's beneficial for patients).
When I was taking several different medications, I started seeing why this service would be useful, even as a relatively organized, non-impaired person.
Mind sharing the countries? Because it's only now after moving to certain 1 country that I see the "pill counting" and "translating scripts into layman terms" as parts of a pharmacist's job.
To me it was an absolutely American thing from the movies: I've always had the posology written by doctors already in layman terms, and nobody counts pills, you just get the number of boxes needed for the period of treatment (e.g. now for a treatment for which I need 38.5 pills I got exactly 38.5, in all other EU countries I've lived in I'd get 1x40/2x20/4x10 boxes).
Oh yeah, my French family has leftovers of every antibiotic under the sun. 7 day prescription, 10 days dispensed, over enough years, they end up with a looooot of extra while still taking what was prescribed. and well sealed to boot!
Pillpack has been around for a long time, Amazon acquired them and launched Amazon Pharmacy, which delivers medications in traditional bottles - but kept the old Pillpack format around - which is a cellophane pack that is like a single use plastic sachet.
My guess is that the liability increase for mispacking the pills outweighs any incremental mail-order pill sales CVS generated with the program. With Amazon starting their program up, the ability to entice new customers is probably worth the risk to them.
Oh, there's no licensing fee to Amazon -- PillPack is just using off the shelf medication pouch packaging systems, albeit at larger scale than most pharmacies.
In the UK don't pharamcies do this sort of thing for you.
My mother's pills wer organised by day and time of day 15 years ago.
ALso comments about how it saves wasted pills don't make sense for me. The doctor prescribes x pills for the course of treatment. So the pharmasist gives you x pills.
Yes for ibuprofen and other drugs you take as needed then you will have some left over as typically you have a headache and take one dose.
> In the UK don't pharamcies do this sort of thing for you.
Yep, they do
> Also comments about how it saves wasted pills don't make sense for me
People don't follow instructions sometimes, and doctors overprescribe for the instructions they give you. My doctor wrote me a prescription for something a long time ago and warned me about the risk of addiction. They said I should stick to a dose, but prescribed me a larger amount because I could take more _if I needed it_ for a day or two. The pharmacist filled the prescription for about 3x what I should have been given without blinking an eye.
It sounds like the doctor trusted you but I don't think you sound happy about it.
There are costs involved in appointments and filling prescriptions and you being trusted with an excess gives the system some flexibility that might avoid an extra appointment or visit to pharmacy.
UK pharmacists are able to to do blister packs but this is a hugely labour intensive endeavour. Specific quantities of each medication need to be dispensed, placed in the correct pocket, checked and double checked. Compared to dispensing a factory sealed box of $X units. As a manual process it does not scale to providing this service for more than a small percentage of patients where the benefit is greatest (memory impairment, etc).
Also in my experience pharmacists dislike having to do this laborious process.
You'll be amazed how many pharmacies in the UK are unable to take 4 boxes from a shelf and put them in a bag without screwing up.
I have a friend who has had to change pharmacies multiple times due to unreliability and incompetence.
> Local pharmacies just apply a markup to get their profit.
You'd think so, but not on medication. Most of them at least.
Looking into it recently since the business fascinates me, independent pharmacies operate more like gas stations selling gas as a loss leader, making it up on convenience items.
Many drugs don't even get reimbursed at break even by PBMs these days.
Within a decade not a single independent will exist.
Local pharmacies absolutely want to work with you on stuff like this, many have for decades already. Like many industries, they are being squeezed out as some Ivy MBA decides they want every ounce and then some of that consumer surplus. This is done on purpose to push patients to the vertically integrated options like CVS Caremark.
They cannot compete in an environment where consumers will walk over a $3 difference, and they get squeezed by PBMs on the other side.
Anyone fulfilling via Amazon is playing with fire in my opinion. It's gonna work until you eventually get hit by the shortages that are only likely to increase. The ability to talk to a human is going to become extremely important, and likely only available to the very wealthy at this point.
Amazon is less taking advantage of scale, and more that of regulatory capture in my mind. The big innovation is being big enough the other monopoly players can't just totally dictate terms.
That’s my biggest concern. After spending time at a generics manufacturer I discovered how difficult it is for them to get to market and make money as the pathways are closed in a lot of modern medical systems.
Further consolidation means more medical system for the rich and less for the poor, and I’m fundamentally against that, especially when the main selling point is convenience.
The mom and pop pharmacies by me keep inconvenient hours. The national chains like CVS are atrocious (long lines, terrible customer service). Switching to getting my pills delivered from Amazon took literally minutes and I haven’t had a single issue. I’m never going back to CVS!
Elderly people have a hard time dosing multiple to many medications, and some meds with narrow therapeutic-OD ranges need extra attention to avoid deadly mistakes.
Really annoying when these websites/services do not state clearly that they are operating only in US. Am I just suppose to guess it by the fact that phone number validation is US one?
Sweden's state-owned pharmacy has more or less the exact same service, so I don't think you can make such a broad claim: https://www.apoteket.se/doskund/
I find that day-based medication organizers don't work when I have a non-24-hour sleep schedule. I ended up writing down dates and times of doses on a paper notebook, because pill planner apps aren't built for non-24 schedules either, the one I found on F-Droid didn't record times which are useful for optimally spacing medication, and I kept forgetting to either take or record medications in my locked phone.
I assume they mean because a service like this is tied to specific time of day rather than an activity.
e.g. you might take some pills right after you wake up and some pills right before you go to bed.
If you wake up every day at 7am and go to sleep at 11pm then that's easy, but if your schedule is constantly fluctuating (go to bed at 8am and waking up at 3pm) I can imagine how it might become confusing.
Medicine isn't usually tied to activity. It's tied to "this leaves your bloodstream at X/hr. You need to replace it every Y hours". It's possible that it leaves your bloodstream at different rates depending on your activities, but I don't think doctors take that into account when prescribing medications.
With a more erratic schedule, "take this pill at 10am on Tuesday" is a more valuable reminder than with a regular schedule where you might take it triggered by a regular event.
Some medications are prescribed with this taken into account actually.
For example if a medication has sedating effects (such as some antidepressants) it may be advised to be taken before bed so this side effect is turned into something generally beneficial (more sleep) and less prevalent during waking hours).
Statins (cholesterol lowering medications) are usually prescribed at night time as this is when your cholesterol catabolism is most active.
Pain relief is often varied around sleep schedules
Things like insulin may be driven by life events and as needed. But I'm talking about regularly scheduled medication.
Antidepressants may be advisable to take before bed as a rule, but it's an excellent example of drugs that are supposed to be taken at the same time every day. Irregularly moving around the hour you take the antidepressant makes them less likely to work.
That's why irregular sleep schedules aren't a good reason to move medication.
Another factor is that "take X when you wake up Monday and Y when you go to bed Monday" falls apart if you stay up past midnight (then you're taking the second Monday pills on Tuesday), then if you wake up later at 10 PM Monday and go to bed Tuesday afternoon (pretty soon you're taking both of Monday's pills on Tuesday and need to skip taking a day in your pill tracker), whereas recording the last time you took a pill allows you to space them approximately 8 hours apart regardless of the date/time you last took one.
My company changed FSA card providers and PillPack wouldn't let me use my FSA card moving forward because they kept trying to put a $1 preauth on it which my FSA card vendor kept rejecting. Pillpack's response was "lol, too bad" and I ended up having to go back to traditional pharmacy services.
From there I ended up moving onwards to try using medication dispensers to help me keep track of my medications -- finding Hero Health, using that happily for a couple years, until they decided to raise the service price from $30 to $50 a month for just the dispenser alone.
Now I use a multi-partition vitamin cup with custom-printed labels (giant quantity indication, photo of each pill, markings/imprints, and name/dosage) and just manually dispense each pill and twist.
I’m lucky enough to not really need daily meds but went through a few supplement/nootropic phases and was surprised by how boring, mundane, and unsolved the sorting and taking pills problem is.
I remember reading Distress by Greg Egan and people had a “pharm” machine that would print out specific meds they need. Including things like mixing caffeine and vitamins to make up for a hangover or massive infection.
I wish I had one container I dumped everything into and just press a button and it figured out and spits out what I need to take then.
These individual packets seem close.
Also, the first company to get an AI to just sort out all the madness of back and forth with doctor, insurance, pharmacy to get right dose and price without lots of mental pain and frustration will help people. This seems closer to that too.
Is this not in general use in the US?
Here in the Netherlands, this is a common packaging strategy offered by most pharmacies, especially for geriatric care.
2/3 of COTUS is on the take for big Rx. It takes taking fucking gold bars for helping a foreign adversary as an "alleged" treasonous traitor to not get kicked out of office but just lose some subcommittee assignments. You can lie about your education, profess belief in whacky conspiracy theories, and not even understand how government works and still remain a representative. Oh, and a few of the latter wingnuts are precipitating an imminent government shutdown because there is zero accountability for behavior. And you can repeat Whitewater in Texas and get away with it.
PBS covered medications are extremely cheap compared to other countries. I had to stay longer in the US than planned a few years ago, and just about needed a second mortgage to get my fairly standard meds. Unaffordable without insurance.
If you don’t like your pharmacist, shop elsewhere. There are plenty of excellent ones with a strong desire to help. They probably don’t work at Chemist Warehouse though.
The Pharmacy Guild does its best to suppress competition. Regarding the PBS, the government tried to make it easier/cheaper to get repeat prescriptions and they lobbied hard against it, turning pharmacies into party-political platforms, so the chronically sick and elderly would be forced to go in every month instead of every two months in the hope that they’d buy their retail products.
They lobby aggressively.
To get a prescription delivered home in Australia, you need to physically post the original prescription.
Wouldn't grate so much if i didn't get such incredibly poor service every time I go in there. The few times I've actually dared to ask them for information about what they just dispensed me they looked at me like I'm an alien and fobbed me off with completely generic advice I could have read from the packaging.
What happened to 3-D printing pills?
I remember there was a startup that did that - the idea was to avoid having to take several pills and just print what was needed.
But I cannot recall the name... what happened to them?
3D printing pills? That'd be as dumb as 3D printing butter or a soda can.
It's called compounding: taking the active ingredients and smashing them into 1 pill is trivial. Manual tablet presses have existed for hundreds of years, and automatic tablet presses have existed for 70.
> Amazon recently recalled something I was taking as counterfeit
Was it from the pharmacy?
> You’ve lost traceability
How is traceability different from pills being counted into orange bottles? That isn’t delivering medication in the original packaging from the manufacturer either.
Many countries in the world use individually-sealed blister packs for medicine distribution.
I think in this case the benefits might outweigh any downsides. Taking the correct medication as perscribed is a major source of stress and problems for many people.
> Medication non adherence in patients leads to substantial worsening of disease, death and increased health care costs.
> and sometimes involves individual constraints (e.g. poor inhaler technique, problems remembering doses etc).
> A third type of non adherence is known as non conforming, this type includes a variety of ways in which medication are not taken as prescribed, this behavior can range from skipping doses, to taking medications at incorrect times or at incorrect doses, to even taking more than prescribed.
Another benefit I've heard (perhaps an extreme version of the third type) is that it cuts down on impulsive suicides. It's easy to throw back a whole bottle of pills and take a month's worth of doses in a few seconds. The blister packs make you really work for it.
This is one of the reasons that suicide by tylenol - which is reportedly very drawn out and extremely painful - is so common in the US compared to other countries. It's available in much greater concentration and quantity at retail than the rest of the world. In the UK, bottles have about 30 tablets.
It claims the previous higher maximum was anecdotally established but later supported as safe by multiple studies and the reason for the article seems to be concern that the new lower maximums could cause confusion in patients and doctors.
And in the UK it's going to be in a blister pack not a bottle, which is a lot more work. You can't even buy more than two packs at a time, so you'd need to go from store to store.
A 16 pack of extra-strength paracetamol, which is more than enough to kill you in one sitting, is 65p at Tesco.
Do you really think someone intent on killing himself will look at a blister pack and think, "You know, if this was in a bottle I'd go through with it, but this doesn't seem worth it, it's way too much work to take me own life"?
Many people who commit (or attempt) suicide aren't really intent on killing themselves. There is ample evidence than putting even relatively minor barriers in the way, making it so that people have to slow down and really reflect on what they are doing is enough to stop some people in their tracks and make them reconsider what they are about to do.
I had never considered that angle, but I know from other examples that even a small impedement to suicide can tip the scales safely for some. A short fence you have to climb over, for example.
Exactly. It also reduces pharma waste since you only get as many pills as the doctor prescribes. In Japan, where I currently live, I have barely any leftover medicaments in my drawers (where my prescriptions usually are packaged in individual sachets).
There were tons of leftovers in the EU, where I lived before - that's wasteful. Not a little bit of plastic.
> first [Canadian] National Prescription Drug Drop-Off Day, which resulted in the return of more than two tonnes of unused medications
> The first is inertia: it takes effort to discard something, but no effort to leave it where it is. The second is a natural inclination to keep something that might be useful later on, particularly if future procurement involves inconvenience or expense.
I used to take an as-needed medication that would build up in times when it wasn't needed if I just let the pharmacy autofill everything that "should" be used up.
Most pharmacies in the US will count out each pill/mL. Most insurers will not pay for more than three months at a time and so the pharmacy won't give you more than 90 days * your daily dosage.
People skip or miss doses (hey, the problem the thread topic is trying to solve) and then pharmacies will auto-fill perscriptions that should be empty. Some people are on as-needed medications that also get auto-filled. I posted some more in a sibling comment.
The most common medication is so cheap that I don't think the US pharmacy handling is worth it. And few packs I've had are more than 90 days worth of pills, with the exception of some really cheap stuff (as in $10 per pack of 100).
Picking up common prescription medication consists of me walking into a pharmacy - any pharmacy! - with my prescription, handing it to them, and telling them "one of this please". They will then immediately retrieve the pack of that medicine, ask me some questions to check for allergies etc. and hand it to me. I don't have to have the prescription sent to a specific pharmacy then wait for them to have the bottle ready and verified by a pharmacist.
Same here, with the added benefits that the prescription is digital. Also, in my go to pharmacy my wife account is linked to mine, so she can pickup my medication as soon as my call with the doctor is done.
In what way would this cut down on wasted medications? Because it’s portioned? FYI you can still find pharmacies that will pack your medications in blister packs for a nominal surcharge or sometimes free. Or just use a pill box.
So again, find one of the many pharmacies that do blister packing. They don’t all do it tbf but a lot do. A lot of Walmart locations do and many mail order pharmacies will.
Traditional blister packing has been around for years, this isn’t a novel idea. This is just a wasteful implementation
A lot of expensive medication is cheap to manufacture. The money goes to R&D and profits (similar to software). For those medications it's likely that reduced waste would lead to the manufacturer raising the price, keeping the total cost similar.
For older people who actually do need to take multiple pills, I think this is fantastic. There’s no risk of taking multiple doses because you forgot whether you took one or not.
Nonetheless, it would be interesting to see this made of paper.
If you take multiple medicines, and/or have a complex medication schedule, it’s super convenient. It self audits whether you took your meds already and avoids spending a lot of time sorting pills into organizers.
It’s also really convenient for travel; just tear off the packets for the time you’ll be away.
[ed] fixed autocorrect error