Automated dispensing machines hit doctors' offices

A Pennsylvania company is marketing automated medication-dispensing machines for doctors' offices. Company officials said the use of its technology helps reduce overall drug costs, creates new revenue for doctors, and improves prescription fill rates. And they assert that pharmacists can be part of the company's future. QuiqMeds, near Philadelphia, has placed a handful of the machines locally.

"At our core, we're a technology company, offering the hardware and software needed to create new opportunities," said CEO Herb Cohen. "We believe there is a significant role for pharmacists to play in partnering with us, either as franchisees or in some other way, to offer improved service."

QuiqMeds is like MedVantx, in San Diego, which uses machines called Sample Centers to distribute generic samples in doctors' offices. But while MedVantx, at least so far, does not stock refill, QuiqMeds is more ambitious. Although Cohen would not say exactly how many machines he has in place, he did say they are stocked with both generics and branded drugs and potentially can be used for refills. The technology is more than a customer service tool, according to QuiqMeds marketing materials—it is a new profit center for doctors, who lease the machines but can set their own drug prices.

The convenience of QuiqMeds machines can also affect profits by increasing patient compliance rates, said Cohen. "Do you realize that 30% of prescriptions go unfilled and that the refill noncompliance rate is even higher? That is a lot of lost revenue that pharmacists can make up if they are stocking the machines," he said. "And it improves medical patient care."

Cohen went on to say that the pharmacist's role with his company—whether marketing the technology, stocking the machines, or in some other, as yet undefined, capacity—would depend on state pharmacy and medical boards. "That would be on a state-by-state basis, depending what the regulations in that state govern the dispensing of drugs," he said. "But we believe this will be good for pharmacists, and we want to make this opportunity available."

According to the National Association of Boards of Pharmacy, policies governing distribution of drugs in doctors' offices do vary by state. Most medical and pharmacy boards allow physicians to dispense drug samples in their office, said NABP executive director Carmen Catizone. "At issue for most boards is what happens once the patient is given a medication," he said. "Boards want some process in place that ensures that the patient has been given the correct medication in the correct dose, and that someone qualified can answer any questions."

The emergence of the ATM-like machines in the past couple of years has been met with skepticism by many pharmacists, who say the technology fails to provide the patient care they are trained to deliver while dispensing drugs. "The technology simply isn't safe," said Fred Mayer, president of Pharmacists Planning Service Inc. (PPSI), a nonprofit organization in San Rafael, Calif. "We have 107,000 deaths a year from adverse drug reactions and interactions. Lack of pharmacist involvement in dispensing will increase that number."

The QuiqMeds Web site states that the company "is considered a wholeseller of pharmaceuticals and has obtained a license under the Pennsylvania Wholesale Prescription Drug Distributors License Act. It has set up policies and procedures for the distribution, storage, handling, and labeling of prescription drugs. Further, QuiqMeds has set up a compliance program in which all policies are compliant with applicable federal, state, and local regulations."

"More than 14,000 work hours have gone into this," said Cohen. "We want to work with pharmacists to introduce this system to doctors."

How QuiqMeds works

QuiqMeds works like this:

• A doctor writes a prescription, then uses his own computer to fulfill that prescription through a touch screen.
  
• The patient then carries the script to an office staff member.
• The staffer checks the script against what the doctor punched into the computer, prints out an information sheet with labels, and retrieves the preloaded medication bottle from a machine in the doctor's office, using a security code.
  
• The bottle is matched with the printout, and computer-generated labels from the printout are applied to the patient's medical chart and the bottle.
  
• The patient pays for his prescription as part of the office visit.

The QuiqMeds marketing materials are unclear as to the credentials of the staff member, and CEO Herb Cohen said that would be determined "state by state." If the physician office staff member is a credentialed person designated by the physician as someone capable of acting in his stead to check the dosage and advise the patient as necessary, the QuiqMeds process could be acceptable to many state boards, said Catizone. "State boards do not get involved in whether this kind of technology is fair or ethical-only whether [the technology] protects patient safety," he said.

THE AUTHOR is a writer based in Gettysburg, Pa.