Within the next year or two, retail pharmacists could find themselves working alongside ATM-like machines that supply prescription drugs directly to the patients, without the pharmacists ever having to meet them.
Introduction of these machines is at a very early stage, and the jobs they are permitted to perform will initially be limited, depending on the state. In California, for instance, a machine has been supplying refills only at a Longs Drugs store since early this year.
Patients register at the pharmacy to use the partially automated system, then order prescriptions as usual. Pharmacists fill the prescriptions and place them in the machine. Patients retrieve their medicines from the machine by entering a user name and password and swiping a credit card.
Proponents say the systems could reduce waiting time for patients and let pharmacists focus on counseling. And if used in the right way, the systems might very well be a boon to pharmacists rather than a threat, said John Cronin, vice president and general counsel at the California Pharmacists Association (CPhA). "They can serve a very useful purpose," he said, replacing the work of a clerk, not a pharmacist.
The concern, he said, is that the technology could be used in ways that reduce counseling and other contact between the pharmacist and the patient. For instance, because the machines can operate even when the pharmacy is closed, stores might try to reduce pharmacy hours once a machine is installed. The systems conceivably could also become a step in a larger automated process, with robotic dispensers at regional centers filling prescriptions that are then shipped to stores and packed into machines by technicians.
Systems are currently being made by Asteres, in Del Mar, Calif, and by Distributed Delivery Networks, a unit of Amistar, San Marcos, Calif. A handful are going into trials; Asteres founder Linda Pinney said she expects mostly trial use to continue through next year, with widespread rollout in 2007.
Pinney said an Asteres ScriptCenter machine costs $65,000 to $95,000, including the sometimes extensive cost of integration into pharmacy information and retail systems. Bob Hansen, Asteres' chief pharmacy officer, said one machine currently holds about 480 prescriptions. To load the machine, a technician places each prescription into a bar-coded bag, manually swiping the bar code on the bag and on the bottle so that the machine can identify each prescription. Then the bags are placed into trays in the machine. This process takes 20 to 30 seconds per prescription, Hansen said. It takes about 45 seconds for the ScriptCenter to deliver a prescription to a patient, he added.
Pinney said the biggest demand for the ScriptCenter is from grocery stores with limited pharmacy hours that want to provide prescriptions to patients when the pharmacy is closed.
But that goal generally conflicts with state regulations preventing drugs from being dispensed when a pharmacist is not present.
For instance, the machines have so far only been approved for general use in Hawaii, where they can be used the first time a drug is prescribed as well as for refills. But current regulations allow their use only during pharmacy hours, and only in cases when pharmacist counseling would not normally be required. They cannot be used for Medicaid prescriptions or for controlled substances.
The California Board of Pharmacy is discussing a change to regulations to allow general use of the systems, but if approved, that probably would take a year to come into effect, said assistant executive officer Virginia Herold.
In the meantime, the California board has approved a handful of waivers allowing machines to be used for refills only in specific cases, including times when the pharmacy is closed. To obtain a waiver, companies must outline their intent in a letter to the board, then present their plans in person, Herold said. She added that waivers have been granted to Longs and Safeway.
John Cronin of the CPhA said that it is arguing that waiver applications should include a services plan detailing pharmacy hours. If a pharmacy subsequently decided to reduce opening hours, it would be grounds for reconsidering the waiver.
Mr. Faden is a freelance medical writer based in Portland, Ore.
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