The Pharmacy of the Future Is Ready For Your Bathroom Counter

All the kitchens had one thing in common: a mess of orange pill bottles scattered on a counter, sticky notes or spreadsheets posted nearby to track when to take each little pill. TJ Parker saw the same scene everywhere as a teenager delivering medication to his father’s pharmacy clients in small-town New Hampshire. In each house, he was struck by how these people—suffering from very different maladies—shared the stress and difficulty of managing their drugs. One woman couldn’t read the text on her pill bottles, so Parker would write the first letter of each medication in sharpie on the caps. It wasn’t much, but it was all he could do to help her take the right pill at the right time.

Parker thought about her for years. Through college. Through pharmacy school. Through MIT’s innovation startup competition—which he snuck his way into, despite not being a student at MIT—and through the early days of his friendship and collaboration with MIT engineering student Elliot Cohen. And in 2013, the pair started their company PillPack, which presorts pills into simple, date-stamped packets. Today, PillPack launches a new pack dispenser and operating system to bring that approach to more people, making it easier for people to take multiple medications correctly.

“Our first three years have been maniacally focused on simplicity and convenience,” says Parker—reducing the pain of managing refills, portioning out doses, calling insurance companies, and going to the pharmacy. “Convenience” is sometimes a startup buzzword that belies how unnecessary the product actually is to daily life, but in this case, that convenience is intended to solve a real problem.

One in five Americans takes more than three medications a day, according to the Centers for Disease Control. The World Health Organization estimates that roughly 50 percent of patients in the US with chronic illnesses don’t take that medication exactly as prescribed—mistakes that can be deadly. A review in the Annals of Internal Medicine estimated the problem accounts for 125,000 deaths a year in the US. When you miss doses, not only is your individual treatment compromised, but it becomes harder for doctors to diagnose your symptoms (is this symptom from a disease or the misuse of a medication?) and for researchers to accurately track the long-term effects of medications.

PillPack is trying to solve the problem of drug adherence by simplifying your medicine cabinet. Medication arrives in the mail presorted into clear plastic packets, each marked in a large font with vital information: day, time, pills inside, dosages. These are ordered chronologically in a roll that slots into the dispenser. Let’s say you need to take four different pills in the morning and two others in the afternoon every day: Those pills would be sorted into two tear-off packets: one marked 8am, followed immediately by the 2pm packet.

To get the packets to your dispenser all presorted, PillPack pharmacists (remote, in New Hampshire), use the company’s operating system to track your meds. Formerly, the company had been using a hodgepodge of third-party software, designed to process single prescriptions. The new system, dubbed Pharmacy OS, automatically requests refills, reaches out to insurance companies for patients, and makes sure all prescriptions are on the same cycle so that one medication doesn’t run out before the others.

Once that information is in place, a pharmacist sorts all your medications according to your doctor’s instructions and loads them into an automated machine that deposits them into the clear packs and prints the labels. Then, each packet is inspected by a computer vision program that’s been trained to recognize pills by size, color, and shape. That AI checks to make sure the pharmacist hasn’t made any error in divvying up the pills–and if it flags anything, another pharmacist checks those packs by hand. PillPack’s pharmacists, like a traditional store-based one, take an active role in keeping prescriptions up to date, monitoring drug interactions between medications, and contacting people to discuss any changes in their medication routines.

PillPack

All that complexity disappears once the pills slot into the new dispenser, which customers can buy for $29. It’s a plastic rectangle (in four colors!) with a slot at the top that you pull packets from—a simple innovation, but an important one. “There’s no way to load it incorrectly,” says Colin Raney, who leads design at PillPack and formerly ran the design firm IDEO’s Boston office. Raney went through earlier prototypes that involved screens and IOT capabilities, but ultimately landed on something that requires no tech savvy at all.

Since its inception three years ago, PillPack has gotten $118 million in four rounds of VC funding, allowing it to employ 500 people, including 300 pharmacists, pharmacy techs, and customer support representatives at its filling center in New Hampshire. In its early days, the company charged a monthly fee of $20. But now PillPack has enough customers to scrap that fee and make its money the same way retail pharmacies do: from fill fees per dose, a charge that’s built into the cost of medication at any major retailer like CVS or Walgreens. Parker says they now have tens of thousands of customers, though he won’t reveal the exact number (it’s somewhere around 40,000).

That’s a far cry from the early days, when Parker and his first employees would have pizza parties at his apartment and email everyone they knew to—as he puts it—“sell them drugs.” Back then, PillPack had nine employees, 50 customers, and one customer service rep: Parker, who took all the calls to his cell phone. In 2014, a customer called and told him she’d struggled with addiction for years, but that PillPack’s design was enough of a nudge to take her meds correctly that she’d been doing better.

“Her whole thing was, ‘I don’t want to screw up a month of my meds to get access to this one pill.’ You could cut them all open but, then you’re screwed,” he says. You’d have a hard time knowing which medication was which or when you were meant to take it.

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The system is also useful for people with dementia who may have problems remembering whether they took their pills, for people with multiple caregivers to help keep track of everything, or for anyone monitoring someone’s medicines. Along with the dispenser and packets, patients can use an app to interact with PillPack pharmacists—or call, or email, or use snail mail, whatever their generational preference may be. That app hooks in with Pharmacy OS, running the show behind the scenes.

Parker’s father, who’s now a VP at PillPack, didn’t think his son and the engineers at the company would ever manage to create a pharmacy software system of their own. “He’d seen it done and failed so many times in his career. He’d say, ‘I know you think it’s a good idea and you love software, but it’s impossible,” Parker says. When the team finalized it a few weeks ago, Parker announced it with an email that read, “My Dad never thought this day was going to be possible.” His father replied-all: “It’s true, I didn’t.”

The system they’ve built certainly promises to improve medication adherence. But the next step—and the true value of Pharmacy OS—is to test that premise. With the ability to easily track medication data within the system, PillPack can conduct a study to see exactly how effective the product is and which kind of patient is most helped.

The OS is also what will let PillPack scale its operations up to accommodate more customers. In the US, there are 30 million people who take more than three pills a day—people just like those neighbors Parker used to visit back in New Hampshire. In 2017, that kind of individual care comes not with a bunch of orange bottles marked in sharpie, but a sleek medication dispenser.