What Amazon must do to succeed in pharmacy.

Even though I am a physician, my wife prefers to pay for second opinions and receive her prescriptions from a “real” doctor. 

Recently, at a "real" doctor’s appointment, my wife received three prescriptions - an antibiotic for our then snotty child (something I wouldn’t have prescribed) which required an immediate purchase, a new chronic medication refill (she only had a week’s worth of pills remaining at home), and a sleeping pill prescription for an upcoming overseas trip. When it came to fulfilling them, even though there are 68,000 pharmacies in the USA, it was easiest to have them sent to the pharmacy across the street.

Amazon wins when patients are in control of their consumer purchasing. They succeed when we are in the mall and “just browsing” but secretly ordering our sunglasses online (way cheaper!), or when sitting at the office ordering new stationary, or when flicking through the Black Friday sales on our App in front of some brain numbing reality TV shows. Amazon wins when we consumers are in charge.

However, when it comes to prescriptions, things are slightly different. In fact prescription medicine is one of the few examples (or maybe the only example) of a process that when digitized, ultimately made a system even less consumer centric (is that possible?). When implementing ePrescribing across the USA (essentially digitizing prescriptions), we took portable paper prescriptions away from patients (who used to have some element of control), and informed patients that they can no longer touch or engage with their prescriptions until they purchase them (for those unfamiliar with ePrescriptions in the USA, digital prescriptions effectively bypass the patient, moving from clinician directly to the pharmacy of choice). 

This system leaves patients data-less, without understanding what they were prescribed and why, lacking control and price visibility, at the mercy of the stockists and opening hours of the pharmacy they pre-selected (maybe months ago), and confused as ever in determining which pharmacy is in- or out-of-network. No wonder we have prescription abandonment rates of 50% by 6 months, with 30% of patients never even picking up their first prescriptions!

As Amazon makes this brave foray into the prescription market, Amazon’s challenge, like all online pharmacies who recognize how painful prescription management can be, is to convince patients that during their anxiety provoking and dense 8 minute clinician appointment, they must turn their attention to where their prescriptions are sent - and request Amazon or Pillpack. A huge challenge.

What Amazon and all other boutique approaches to the pharmacy experience require, like with all other consumer centered approaches to retail, is a new way to enable consumers to own their prescriptions on their phone. So that consumers, once removed from the pressure of the consultation, can shift their attention to their medications and how to manage them most effectively.

My wife would have done better to send her chronic meds to her mail order PBM, to get her sleeping pills at Amazon, and her antibiotics at Walgreens - yet in today’s world this would have been too hard. 

We at ScalaMed believe in choice and consumer empowerment - whilst supporting patients to make wiser medication decisions. ScalaMed re-routes prescriptions directly to the consumer, where prescriptions are accessible in a digital prescription wallet on the consumer’s phone - for them to direct on their terms. We make it easy for consumers to engage with their health data, and to be in control of their prescriptions. We make it simple to give patients choice and price comparisons. We are working hard to help put consumers back in the center of their journey, and open the pharmacy market up to new opportunities. What we at ScalaMed can’t do though, is convince my wife that I am still a “real” doctor.