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A few years back I lamented what I thought was a shortcoming of start-ups interested in the pharmacy space. As a pharmacist sincerely invested in the digital health space, it was hard to see so many innovators tackling almost every sector of healthcare but the pharmacy space. Since then I have been pleasantly pleased to see a rapid growth in different areas of pharmacy being disrupted but also disappointed some areas have not even been touched. Nonetheless, when I saw Halle Tecco (@halletecco) post on Twitter regarding several pharmacies related start-ups, I just had to have a look at how much has developed in the past few years.

My Process

For now, I have limited my search for disrupters in pharmacy to the following areas. I recognize that this is not all-inclusive (see comment at end of this post) but focused on areas I feel really relevant to pharmacy. Currently, I am debating, for instance, medication adherence services (e.g. PillDrill, Proteus Health, AiCure) though I still haven't seen them integrated heavily into the pharmacy environnment as of yet.

MEDICATION DISPENSING - Essentially companies that are rethinking how we get medications to our patients compared to traditional businesses. While CVS, Walgreens, Rite Aid, Walmart, and all the other retail settings dominate the pharmacy landscape, it will be interesting for me to see if these new companies can carve out a sizable niche of the market.

MEDICATION DELIVERY – Basically companies that bring an ‘Uber’ process to getting medications to patients using their services. One important note is that many of the medication dispensing start-ups are primarily mail-ordered/delivered drug services, and can overlap with this a bit. I kept companies who strictly partner with established pharmacies and do their deliveries for them in this category.

VITAMINS & SUPPLEMENTS - A staple of most pharmacies and grocery stores, and the ubiquitous Vitamine Shoppe, new startups are now creating patient-specific services aimed to get them the vitamins and supplements they need on a personal level, mailed to their home. 

MEDICATION COST SAVINGS – Start-ups focused on reducing costs of medications for patients, primarily through the use of drug coupons.

MEDICATION PRESCRIBING – Companies that are using Teleservices to have patients talk with a clinician remotely and get care and prescriptions e-prescribed to their pharmacy.

SPECIALTY PHARMACY SERVICES – A small area, but growing, where start-ups are looking to tap into a costly market focused on highly expensive medications.

MEDICATION INFORMATION – While Wolters Kluwer (Lexicomp), IBM Truven Health (Micromedex), Elsevier (Clinical Pharmacology), AthenaHealth (Epocrates) offer drug references primarily geared to clinicians and partnered with Google for their searches (Micromedex), there is now a slew of companies looking to offer drug information geared towards consumers. Many of the drug coupon companies offer similar services, but those listed here are exclusively focused on this process. 

MEDICATION STORAGE – Oddball niche, but interesting in that some companies are looking to help pharmacies and patients store their medications better.

A Look at the Companies

Medication Dispensing

Well, we all know CVS, Rite Aid, Walgreens, and the food store pharmacies. But in the past few years, a few others are now creeping onto the market. These are all primarily online based operations that mail/deliver the medications to patients, and lack any brick-and-mortar set-up that traditional pharmacies operate out of. Now, mail-order pharmacy isn't anything new, and rather these companies are relying on novel packaging and other services to rope in patients, along with the branding that they are more personalized compared to the current pharmacy marketplace. PillPack is arguably the biggest name of these companies, though, several other companies are emulating their strip-packaging system and now serve as competitors (I mean, CVS also does it as well I found out, but they seem not to be marketing it heavily).

• While PillPack deserves the credit for branding a pharmacy service used for years as a commercial way for patients to use in their homes to manage their medications via personalized strip-packaged drugs, other companies are now looking to get into that market, including divvyDose and Alto Pharmacy (formerly ScriptDash).

• Outside of getting patients their medications something different than in an amber vial, some companies are looking for a more technological approach with their packaging for adherence and personalized set-up like Insightfil, who mail patients a packaged tray of their medications.

• PopRx and Capsule Pharmacy are aiming to redefine the overall pharmacy experience, trying to leverage their pharmacy staff (which I like) and expanding services using digital health tools. Alto pharmacy is rather similar, with their recent acquisition of Round Health, a smart pill bottle for patients to use as well. Then you have NimbleRx who are seeking to be a fast delivered pharmacy services, that combine a pharmacy and delivery service.

• Lastly, Medavail is taking on the RedBox challenge, creating medication pickup points for patients to get their drugs from. These I see better suited outside of clinics, walk-ins, and ERs where pharmacy access may be limited.

Medication Delivery

I remember when I worked at an independent pharmacy as an intern and delivering medications to the community. At times a fun job (depending on the time of year), I always wondered if there was a better way. Now, in the era of on-demand service and the "Uber mentality," start-ups have started to look into rapid medication delivery services (primarily in urban centers) to get patients their medications quicker than the 15-minute wait or going through the drive-thru.

Overall, these guys are pretty similar (in my book) regarding their premise. ScriptDrop, Phil, ZipDrug, and GetMyRx all aim to partner with pharmacies in your neighborhood to get you your drugs as quickly as possible, and in some cases, help reduce cost and spending and help organize delivery services to other family members (which may be good for a caregiver route). Personally, I see this being the "survival of the fittest" with whoever can partner the most and carve out a bigger region than the others.

Medication Cost Savings

In an environment where drug prices are outrageous for multiple reasons, looking to save some money on drugs is always a good thing for most patients. That being the case, we are seeing a large rise of start-up drug coupon companies (I mean, I see these things in my clinic and at multiple health centers I now visit, including my son's pediatricians office). I find it amazing the big deal was Walmart’s $4 dollar generic drug costs a decade ago and now we see apps that can find the lowest cost in your neighborhood.

• If you haven't had to use GoodRx or Blink Health or WellRx yet, I think that's a good thing, but if you ever find yourself needing some quick recommendations on where to get drugs cheap they may be a great service. As a pharmacist working in free clinics and in a cardiac center, I routinely use these for my patients between insurance or just having issues with cost.

• RxRevu now is rather different, and more from a clinician standpoint, a way to estimate cost before prescribing them. For pharmacy, I think this is a great thing as I can't count how many times I am asked how much a patient's drugs are going to cost them with their insurance program.

Medication Prescribing

Let's face it, without prescribers, pharmacy wouldn't work (at least here in the US). That being the case, when minute/walk-in clinics started to grow and expand into pharmacy chains and food stores, there was a great business opportunity there. Now though, thanks in part to telemedicine services and e-prescribing, we see remote clinical assessments. Interestingly, I noticed that many of these start-ups are niched in nature as well, focused on women's health (e.g., birth control), mental health, and even dermatological products.

• The competition is fierce here, and I think minute-clinics and walk-in centers may have some burgeoning competition in the next few years depending on how these companies like HealthTap and Lemonaid Health pulls things off in providing teleservices and e-prescribing for health conditions in the home setting. There is still a bit to go, but I feel they are worth keeping an eye on, because at the end of the day they may be solutions for common conditions, but they aren't going to set a broken leg.

• The Pill Club, Nurx, and Pandia Health, Maven Clinic are more niched in that they serve a clientele focused on women and birth control, though Nurx also provides PrEP as well, and Maven offers mental health services (which I honestly expect to see expanding here shortly).

• Then, and I expect to see more of these, you have these companies going for a remote personalized health approach. Curology I think is a good example, where dermatologists create a 'personalized' skin care product (though really it's only so many ingredients that can be compounded together, but I like the idea) for a patient's needs.

Vitamins & Supplements

In an age of delivered food (which I think should be based on your personal health, why hasn't anyone made that yet?) like Blue Apron and Hello Fresh, I suppose it comes as no suprise someone is doing the same with vitamins and supplements. Vitamin Shoppe and pharmacies are having a bit more competition with companies like Care/Of (which I'm gonna call PillPack vitamins), VitaFive (what is with gummy vitamins, is this playing to a generation who gobbled down Flintsone Vitamins?) and Ritual offering personalized mail-ordered vitamins delivered to your door.

Specialty Pharmacy Services

Drugs cost a lot, we already established that, but some are just enough to buy a new car. That's where specialty pharmacies come into play, a place to have those with training keep the inventory safe and make sure patients are taken care of with those medications. While CVS and other pharmacies are large in this market, we see others trying to tackle this space or help with communication between patients and pharmacies. I don't expect a lot here at this time due to the niche factor of the specialty market and cost, but we may see it get bigger. ZappRx offers a service to help the communication between providers and streamline the process of getting specialty meds for patients, while Senderra is a specialty pharmacy. Honestly, I think there's a few more here I am missing, feel free to let me know.

Medication Information

So just to get some conflict of interest out of the way, I am a clinical writer for one of these start-ups [Iodine]. These companies offer a novel way of getting drug information into the hands of patients that is different compared to previous drug information companies strategies. This includes crowd-sourcing patients experiences with their medications along with data taken from clinical trials to build a new database for patients to assess how the drugs may work for them. Most of the data is patient-oriented and not just taken directly from a package insert such as what PatientsLikeMe (teamed up with Walgreens) and Iodine (now with an open API) are doing. RxWiki was integrated into Digital Pharmacist to create a portfolio of solutions for independent pharmacies to offer different services and databases, including patient-friendly drug information.

Medication Storage

Now this one surprised me, and I wouldn't be shocked if I missed a few. Working in the pharmacy, the inventory is essential. No patient wants to get a medication that doesn't work because it wasn't stored properly. I've personally worked in situations where a fridge stops working, and we scramble to move our drugs around (e.g., insulin, biologics) so that we don’t incur a loss and are unable to supply drugs to patients. So now we have these companies like MedAngel and iApotheca entering the space to help prevent this problem I suppose, and also to help patients. The market here is a bit odd for me, and I consider it a niche area, but hey, it's something new.

So Whats Missing?

While these previously mentioned sub-pharmacy sectors are being disrupted heavily by new start-ups, there are still several areas I am surprised to see some areas are still not being addressed (if they are, let me know in the comments! – I may have just missed them). I mean I won't lie, I've had my own ideas, but here some I think may be worth mentioning.

Transitions of Care and Medication Reconciliation
For me, in my day to day setting, this has been a bane on clinical practice. Clinicians and pharmacy team members spend countless hours just trying to figure out what medications their patients are on. Call two pharmacies, their LTC facility, and a previous doctor who uses a different EHR just to figure out what a patient is on. I feel this is one area that could be tackled better.

Personalized Medicine (Literally) & Pharmacogenomics
Seeing what has been going on with personalized supplements, I am a bit surprised as well that companies aren’t trying to sell a personalized medication service based on a patients pharmacogenomics profile. I am thinking a company that partners with the many cheap genomic profiles (e.g. 23andMe) to sell a service that can look at a patient’s medical history, and then give them a recommendation on what treatments would work best for them if needed in the future to share with their health team, and pinpoint potential drug interactions and other issues to ease the burden of choosing the best medication therapy for them.

Pharmacists as Providers
I didn’t see much here trying to have pharmacists use their clinical skills. It’s all about the drugs, costs, and speed of getting them to the patient. Nothing about pharmacists being used to helping improve patient clinical outcomes or health coaching. With the push for medication therapy management, vaccinations, and states rolling out prescribing rights via collaborative practice, I feel there is an untapped niche here that can be useful. I would say the biggest audience would be independent pharmacies and consultant pharmacists looking to make money outside of just dispensing services.

The Elephant in the Room

Amazon. Yes, I know, a bit of news has been talked about, but if you want my thoughts on it, see my other post. 

Well, thank you for reading through this, and I welcome your thoughts or recommendations for companies that I should include or categories I can expand upon. I consider this a first version, that will be updated routinely, and I would welcome your help!