A host of new startups aim to bring medication to patients in smarter, more convenient ways.
By Nicholas Genes, MD, PHD
What part of telemedicine is often forgotten? The medicine.
We’ve come to expect virtual visits with specialists far away, and are nearly living in a world where our apps and wearables aggregate and transmit health data, to inform medical decisions. But when it comes time to obtaining medications? We’re still dependent on a doctor’s prescription, a trip to the pharmacy, and a plain old bottle of pills. If the prescription doesn’t get filled, or the patient can’t follow the regimen, or has issues with the drug, well, hopefully they can have a prompt follow-up visit with the prescriber.
A host of new startups aim bringing medication to patients in smarter, more convenient ways. They may be able to improve adherence, and simplify an especially shaky part of healthcare. Along the way, they aim to fulfill the promise of telemedicine. Here are some of the most distinctive companies in this field.
This New York City startup launched earlier this year, coinciding with the state’s e-prescribing mandate taking effect. The idea is simple – replace the corner pharmacy, with its inconsistent stock, inconvenient hours, and a public counter that’s not exactly conducive to private conversations about medications and side effects. With Capsule, doctors don’t have to browse a list of local pharmacies – they simply e-prescribe to Capsule’s massive warehouse, where every med and dosage is likely to be in stock. Capsule’s team fills the prescription and delivers it, for free, wherever a patient specifies – home or office, day or night. Patients can message or call the pharmacist with questions at any time, instead of just at the store. The company can afford free delivery and expanded hours because they’re saving so much on real estate, compared to typical pharmacies. It’s a model that’s attracted a lot of funding in a short time, including from Oscar co-founder Josh Kushner. You might say, in the telepharmacy startup space, Capsule combines the convenient delivery of prescription drugs that ZipDrug introduced last year, with app- or web-based on-demand availability of pharmacists popularized by RobinHealth and TelePharm.
Patients on complex, multi-drug regimens still must depend on a confusing array of difficult-to-use pill bottles. While vendors offer devices and apps to organize medications and remind users when to take them, these systems come with their own headaches, and still require a degree of discipline and tech-savviness that many patients lack. The result? Missed doses, switched meds, or accidental overdoses, and all their associated consequences.
PillPack pre-sorts medications – including OTC meds – into a roll reminiscent of a tape dispenser. You receive a new roll by mail every two weeks (PRN meds are delivered in a separate, more traditional-looking bottle). Pull on the tape, peel off a packet labeled with the appropriate date and time, rip it open and take your meds. They also offer on-demand app messaging with a pharmacist; this access, plus frequent medication deliveries, are both free (they can afford these services, they say, because of revenue associated with increased adherence). PillPack has raised close to $100 million in funds, and is now operating in all 50 states. However, Walgreens and CVS have both acquired multi-drug dispensing systems in recent years and may be preparing to launch competing services.
SMART PILL BOTTLES AND DISPENSERS
It’s certainly a clever idea: combine audio and/or visual reminders for patients to take their meds, with sensors to track adherence, and wireless technology to communicate that adherence to care team. AdhereTech’s approach is to cram all that tech into one cellular-enabled device with a long battery, while Round Health distributes some functions to its smartphone companion app. uBox does a bit of both, with device lights that alert you to take a medication, an app for tracking and programming, but also adds a secure dispenser so patients can only take one pill at a time.
Tracking medication adherence is a big deal – in high-risk patients across a variety of conditions, there’s probably no better marker of short-term healthcare utilization. These smart pill bottle companies – and others like them – are undoubtedly looking for partnerships with pharmacies, insurers, managed care organizations - or even the drug manufacturers. If they can bring the costs of their smart pill bottles down, or demonstrate to payers that the increased adherence is worth the price, we could see the day where “smart” pill bottles are the new norm, and people will wonder we ever left such a crucial aspect of care to some of the most vulnerable patients.