Dr. Leke Agbejule BPharm, MSc, PharmD joins the Pharmacy Podcast Nation to talk about Innovation with a Lyft Uber and Amazon spin.

With increased advances in Telemedicine & BlockChain technologies, the landscape of community pharmacy is rapidly changing. These changes, albeit, subtle now, have the propensity to disturb the status quo as we know it today.

It’s a known secret that more prescribers are adopting telemedicine and this trend is only getting expanded into various specialties. This ability has enabled the opportunity to have prompt wholesome medical care in areas hitherto considered to be remote. It’s estimated that there are 266 million cell phone subscribers in the US alone. Opportunities and solutions going forward will have to leverage this medium to reach the majority of healthcare consumers. What does this mean? Many pharmacy patrons have a new world open to them. Currently, 82% of patients pick up their prescriptions in the pharmacy either in person or via a representative. Digital adoption of patrons is key.

Patients are now able to request a refill, pick up medications from the comforts of their palms using their smartphones, and other wifi enabled devices such as AlexaR

This article will explore the possible incursion scenarios of the players in this space.

Amazon

With the direct acquisition of PillPackR, Amazon has positioned itself to be a force to be reckoned with in the pharmacy delivery space. It’s no secret that Amazon simply has mastered the art and science of prompt delivery {Amazon Prime} and regular batch delivery! Amazon fosters a lot of relationships within its ecosystem to such an extent that they participate in almost all segments of the supply chain. Amazon is a strong contender in the sense that they can leverage {and perhaps will} Whole Foods foot print to reach out to prospective pharmacy patrons. Almost every household has an Amazon account and almost 65% of those have Amazon Prime. This enormous market share is bound to turn the industry on its head. Alternatively, Amazon May explore leveraging independent pharmacies to fulfil their patients’ prescription needs.

Besides the use of PillPackR to fulfill customers maintenance medication monthly, Amazon will now deal with how to handle acute prescriptions delivery. With the expansion of evisits, we are beginning to see Complete End to End Digital Medicine {CEEDM]. There are more people using medical apps on their phones to consult with a medical healthcare provider and have such prescriptions sent to the patient’s pharmacy of choice. Upon completion, the pharmacy sends the patient a text message and the prescription gets picked up. Today, this may take about 24 to 48 hours to have the medication in the hands of the end consumer. The goal by these operators is to shorten the lag time to approximately 4 hours. It will be ideal for a patient to start their antibiotic treatment within 2 hours of consulting with a healthcare provider.

This will try to capture the pathway for Amazon into this space. Approximately 54% of prescriptions filled in most metropolitan pharmacies are for new acute therapies secondary to recent consultations. These essentially represent the scripts Amazon will be going for. AlexaR will enable such prescriptions to be picked up immediately they are ready at the pharmacy and have them delivered. There are talks Amazon may partner with Lyft or Uber to carry out the delivery. This couldn’t be corroborated. Our consultants believe this is a feasible approach. This approach will definitely leverage the already established logistics infrastructure of Uber/Lyft

Uber

It is believed UberEats is simply a precursor to UberScripts or UberRx. The online car ride-sharing model is poised to penetrate the pharmacy delivery space. Almost everyone has a Uber account and most have had to use this service either sparingly or on a regular basis. The need to move into this niche is very attractive to both Uber and Lyft both have the same service models and are equal strong contenders.

The ultimate model may be a hybrid of Amazon and Uber/Lyft. This is extremely attractive because Uber/Lyft have logistics infrastructures for prompt delivery

Retail Chain pharmacy Role

The chain pharmacies can remain relevant within this space by offering on site instant delivery service.

LeanGuistics Consulting Group, Miami, FL believes this incursion will affect mostly acute medications and mainly focus on patients that use telemedicine to access care.

It was determined that patients are able to allow for a 2 hour window from when the pharmacies notify them of their scripts to the start of therapy.

StatDrop!

This is a tool {app} to help community pharmacy address the current delivery issues. The tool was developed in response to the percentage of acute medications that are not picked up on time, or delivered to the final recipient, for the much-needed therapy. The solution will be similar to UberEats or GrubHub. This app will help patients pick up and deliver medications from their pharmacy of choice at a nominal fee. Patients will be able to download and register for the service. Upon registration, the patient will have access to all the tools via a widget placed on their smart phone. The patient will request a pick up and a barcode generated will have all the information required to pick up their prescription scrambled in a way to further protect the patient’s personal information. Currently this essentially excludes controlled prescriptions. It is believed patients will be using this for the delivery of antibiotics issued pursuant to Rx sent by a healthcare provider. The driver, a registered Pharmacy Technician, will be able to support all medications regardless of their storage conditions. Insulin and similar medications will be delivers to the patient in a cold pack to maintain the cold chain. The patient will pay for their medication over the phone using a credit card on file with their pharmacy, all these transactions will be invisible to the StatDrop representative. when medications are paid for and ready for delivery the patient will log into our app and request service. The nearest StatDrop representative in the neighborhood will lock the request in -app so as to avoid duplication of efforts, pick up and deliver. This service will be available from 7:00 am to 10:00 pm on a daily basis 7 days a week. The last request for the day must arrive in-app by 9:30 pm. We are looking at 20 30 minutes for medications to be delivered. Note, patients can register for a one time delivery service or enroll for a recurring monthly subscription. It is estimated that 57% of all Acute/Stat medications are not picked up {or delivered}, and 72% are not started as prescribed by the healthcare provider. Using some analytics and tools native to Lean Six Sigma, LeanGuistics Consulting Group of Consultants believe we have the solution. For the purposes of this problem statement, any acute medication not delivered within 4 days was considered late and non-adherent. We used 4 days because the average length of antibiotic course is between 5 to 7 days. Based on the prescription issued by the healthcare provider. The patient should be at the tail end of {or the middle of therapy} by the 4th day.

Using the premise of “Vital Few Vs Useful Many, we believe identifying & addressing the main factor will solution for 80% of the problem. In actual fact, a +5% uptick will save the economy a great deal. Let’s put this into proper perspective. It is estimated that prescription abandonment and lack of adherence within the first 48 hours cost the nation in the region of US$ 200 billion and over 100,000 deaths per year, and when the patient is an infant, this makes it worse since either both parents or one will have to miss work to care for the patient and the cost of childcare for that/those days still need to be paid. At LeanGuistics, we believe that if we can better manage this segment of operation we will make a major dent in alleviating the nation of this staggering ailment. There is no doubt the pharmacies today are smarter and more efficient than in the last 2 decades. Several Lean Six Sigma tools have been built into bespoke workflows to ensure these stat medications are ready on time.

At LeanGuistics, we have identified a few important factors, that if improved upon will stem the tide. As alluded to above, most retail pharmacy workflows have effectively removed waste and variation in their processes to ensure a relatively high level of customer satisfaction is achieved.

It is believed by our consultants that the main factor here is the Accessibility to the medication on time. Several factors are responsible here, but the main culprit is getting the medications into the hands of the patients promptly.

 Other Factors

1. Drug not covered or prior authorization required. Oftentimes when medications require P/A or are not covered the pharmacists are reluctant to reach out to the ER to facilitate a change.
2. Out of pocket Cost of drugs: In some cases, the patients get sticker shocked when they discover the out of pocket cost of the medications. Rather than work with the pharmacy team members to leverage other cost reduction measures, such as leveraging manufacturers coupons to further lower the co-pay, they, the patient, just don’t pick up the medication 
3. Availability of insurance coverage: Whether or not the patient is covered by a plan is a key contributing factor. It’s discovered that subscribers of ObamaCare are always reluctant to pick up medications that are outside the lowest tier of coverage

In the final analysis, improving access to the medication through expanded delivery service will reduce this financial burden on the country.

Dr. Leke Agbejule,

Principal Partner,

LeanGuistics Consulting Group, LLC

https://www.linkedin.com/in/dr-leke-agbejule-bpharm-msc-pharmd-82422827/