Insights

As pharmacists attempt to pivot from pill-dispensing and administrative tasks to patient care, robots and AI software are starting to shoulder more of the back-end work — albeit slowly.

Why it matters: Recent pharmacist walkouts — which could go nationwide next week — point to the profession's high level of burnout and overwork, which automation and "smarter" computer systems could help offset.

Driving the news: Pharmacies are notoriously slow to adopt new technology, but that seems to be changing as the urgency brought on by the COVID-19 pandemic placed unprecedented workloads on pharmacists and pharmacy technicians.

• Walgreens is halfway through building a nationwide network of "micro-fulfillment centers" where robots fill most of the orders for delivery to retail stores.

• Walmart, Hy-Vee, Coborn's and other chains have been migrating to "central fill," which moves prescription prep and packaging offsite and leans heavily on technology.

• Where regulation permits, some chains are using "will call" lockers, where patients can pick up their drugs anytime.

On the software side, new AI programs help pharmacists monitor patients' medication adherence, manage inventory, predict demand for specific pills and identify potential drug interactions.

• Visual AI programs use cameras to "ID which pills are which, and which might have a negative interaction," says George Van Antwerp, who leads pharmacy strategy at Deloitte.

• "Questions around medication, around using a discount card, around 'this pill is a new color' — a lot of those things can be automated using chatbots and voicebots," Van Antwerp tells Axios.

• Meanwhile, generative AI "can help address drug shortages by analyzing purchase and supply chain data to forecast demand and optimize supply chains," according to a Coresight Research report.

Pharmacies are also upgrading their websites, automated telephone lines and texting systems to improve self-service and home delivery options.

• Pharmacy chains are aiming to "free up the time of our pharmacists and technicians at our stores, to really be more focused on talking to patients and patient care," Rick Gates, chief pharmacy officer at Walgreens, tells Axios.

• The pharmacy ecosystem "quite honestly hasn't changed a whole lot since back in the '90s, especially when you look at it from a technology perspective," Gates adds.

By the numbers: Walgreens has 11 of 22 planned micro-fulfillment sites up and running, supporting 4,300 retail locations, Gates says.

• The existing sites are filling between 40% and 50% of the prescriptions for those stores.

• Most such prescriptions are regularly scheduled refills and maintenance-based medications that are easily filled ahead of time.

Case study: Walgreen's 68,000-square-foot micro-fulfillment center in Tolleson, Arizona, uses robots to fill up to 50,000 prescriptions a day.

• Robots handle about 75% of the prescriptions filled at the site, per a company video. The rest are manually filled by technicians.

• Both humans and robots put medicine bottles in bags, which are loaded into bins that'll be delivered to different drugstores.

The other side: The crazy toggling that pharmacists must do — refilling prescriptions, handling prior authorizations, administering vaccines — can't be easily fixed by technology, Mike Johnston, CEO of the National Pharmacy Technician Association, tells Axios.

• "Micro-fulfillment — I feel like it's a Band-Aid," he says. The push by Walgreens "has not resulted in changes in toxic environments," he argues. (Micro-fulfillment is just one of many ways the company is reducing workloads in its pharmacies, Gates says.)

• "It made a good PR piece, just like when CVS came out earlier this year and was so proud of themselves for mandating a lunch break for their pharmacists," Johnston said. "Where would we celebrate that in any other industry? That's a basic human need."

• Pharmacists hold life-and-death jobs since any mistake in filling a medicine bottle could potentially be deadly, representatives of several pharmacist trade groups emphasized.

Yes, but: Pill-packing robots have been around for decades, so customers waiting in long lines for their prescriptions may wonder: Why aren't pharmacies using more of them?

• The answers seem to lie in regulations (which mandate certain levels of pharmacy staffing), cost (robots are expensive, and can't fill all orders) and patient safety (since quality assurance involves a level of human oversight).

The big picture: The retail pharmacy business model is under pressure on all sides.

• Competition from mail-order pharmacies like Amazon Pharmacy and Mark Cuban's Cost Plus Drugs is nipping at the heels of traditional drugstores, though analysts say they haven't yet taken a huge bite out of market share. (Amazon is also launching drug delivery by drone.)

• Pharmacists often aren't reimbursed for the type of "wraparound" care they're trained for, like counseling patients or advising on drug interactions, said Anna Legreid Dopp, senior director of government relations at ASHP, the pharmacist trade group.

• She also cited "inefficient use of technology" as a problem. For example, "many times, the patient's information is not interoperable with the pharmacy's system."

What's next: Expect a lot more automation from pharmacies, whether they're in hospitals, supermarkets or retail stores — including the likely addition of AI-powered humanoid robots, which can be programmed to answer patients' routine questions.

Jennifer A. Kingson & Amy Stern, Axios

October 26, 2023