Amazon is about to enter the Australian retail market and is known to be interested in adding pharmacy to its retail mix of products and services.
Amazon has developed “entry point technology” to a consumer’s home.
It is called the Echo system and it is powered by voice activation technology called “Alexa” which is of very high speed.
The Echo system is disguised as a music playlist so as to become integrated into the daily life of a consumer.
The system is scalable and can add-on other activities such as switching electrical appliances on or off, or ordering groceries, and yes, ordering repeat prescriptions.

It is just about 12 months ago that i2P first wrote about the Echo system and its potential for use in a Pharmacy-in-the-home Program.
Read: http://i2p.com.au/how-amazon-will-dominate-global-retail/

Before Amazon can enter pharmacy space in Australia, it has to first fully develop an offering within its home country that could be adapted as a global model.
Partial pilot variations will be developed and tested in other countries (like Japan) where the equivalent of schedule 3 Australian medicines can already be sold by Amazon online, through the employment of a pharmacist screening a written questionnaire, completed by a consumer online.
This system evolved after intense lobbying of Japanese politicians.

Australian pharmacy regulations will restrict Amazon from owning pharmacies outright, so they will have to develop a business model that allies itself to a pharmacist-owned agency, similar to existing franchises.
Because lobbying will increase in volume and frequency, i2P estimates that open-ownership will be legislated in Australia on or around 2026.
This is only a best estimate however – it could happen at any time

A new model has already sprung up independently in the Silicon Valley area in the US under the trading name of NowRx, which is a cut-down model of a community pharmacy targeting prescriptions and clinical advice without a major retail offering.
NowRx sets up in cheaper rental area (such as industrial locations).

Using robotic dispensing machines it will accept electronic prescriptions from GP’s as well as voice-activated patient instructions through the Alexa segment of the Echo system for repeat prescriptions.
NowRx will also pack Dose Administration Aids.
Prescriptions are then delivered by car for free (as a same day service), but makes a charge for a more urgent delivery in a one to two hour timeframe.
Deliveries are made up to 9pm at night, also weekends.
This is a similar offering that Amazon makes for its grocery customers.

NowRx founder, Cary Breese, said “the company is dispensing 125 prescriptions per day from its Mountain View-based warehouse”.
“We’re changing the model of pharmacy.
We believe the traditional pharmacy is outdated and no longer relevant.”

NowRx,  started operating in January 2017, and has been followed by others including NimbleRx, ScriptDash and RobinHealth , that have come on the scene within the past year.
They have been described as Uber for pharmacy.
NowRx targets its marketing to consumers through Facebook ads, who can request that their doctor use NowRX.
Currently, it has 400 Bay Area doctors in its network.

These new pharmacy companies also offer 24-hour access to pharmacists through smartphone apps, designed to make sure patients take their medications appropriately and receive competent advice, also renewal reminders.
These pharmacists simply have to be “on call” and can perform their advisory services at home or any other suitable location.
This may represent an opportunity for highly experienced senior pharmacists given that economic conditions are stated to become adverse for people on pensions and pensions may have to be supplemented by part-time work that is senior-friendly.

NowRx created a value-added encrypted component for Alexa, to make it fully compliant with US health standards.
It is also negotiating with Google to be able to use its “Home” device – an Alexa equivalent.

Others are also working in this space to create innovative pill containers that will improve safety and compliance.

In Australia, there is nothing to stop a pharmacist (including newly registered pharmacists) from opening up their own warehouse pharmacy in a cheap location that is compliant with Location Rules.
Because it is reliant on electronic prescription gathering and other automated processes it can be operated with minimal staff and low overheads.

Also, because of model style, there will be ample time to talk to each patient even being able to book clinical consultations in the warehouse or the patient’s home.
By building an infrastructure that can service patients in their own home, there is opportunity to link in with other home services for economies of scale and perhaps funding from government sources.
The service can be offered to other entities, such as Amazon, which would allow them to complete their offering, while simultaneously extending the pharmacy’s reach, access to Amazon innovation – even access to their delivery service.

Astute operators could set up to service other “brands” known to be waiting patiently to break into the Australian market (such as Woolworths and Boots).
As an alliance partner, a warehouse model of pharmacy could comfortably position itself in a market space that avoids decimation and might also deter lobbying for open ownership if the relationship works well.
Adapting, rather than actively competing, may be the better strategy for any pharmacist wishing to own their own professional practice.

It certainly creates an opportunity for new pharmacists wishing to break with the old paradigm of a community pharmacy.

A Pharmacy-in-the-Home system would stimulate clinical services and absorb more new pharmacists.
A warehouse-style pharmacy operation can also build to become a full-line Internet extension – there is no barrier to expansion on a number of levels.

Even existing community pharmacies can adapt by creating multi-storey bricks and mortar building environments that can host the new style of warehouse pharmacy, as well as be host to other types of health practitioners.

As warehouse practices mature and have appropriate vision, they can invest in health precincts as a means of one-stop health shopping – improving consumer numbers and attracting people with health needs as a catchment (unlike shopping malls that consist mainly of well consumers).

It only takes a bit of imagination.

The Australian Productivity Commission has recently sent a productivity-review to government that virtually recommends the above warehouse-type system except that it replace pharmacists with technician complete management.
It is also known to favour an extension of the warehouse model to provide a “hub and spoke” system that could supply multiple retail outlets, be they Amazon supermarkets, pharmacies or independent kiosks.
The Productivity Commission is the Australian Government’s independent research and advisory body
on a range of economic, social and environmental issues affecting the welfare of Australians.
Its role, expressed most simply, is to help governments make better policies, in the long term interest of the Australian community.
The Commission’s independence is underpinned by an Act of Parliament.
Its processes and outputs are open to public scrutiny and are driven by concern for the wellbeing of the community as a whole.
However, it is a Skeptic-influenced body and therefore its true agenda, particularly in respect of pharmacy, lies just under the radar and is not generally sensitive or favourably disposed to the pharmacy profession
Further information on the Productivity Commission can be obtained from the Commission’s website (www.pc.gov.au).

There is no doubt that the warehouse-type robotic pharmacy is cheaper to operate, and it is no secret that government policy will continue to strip margins from PBS type dispensing, making the move to robotic dispensing an inevitability.
The solution?
Ensure that planning for a warehouse model begins immediately and ensure that ownership stays with pharmacists and under their control.
PBS dispensing is almost regarded as a “loss leader” special at this very moment, so there is also an opportunity to establish a dispensing catalogue and market it in opposition to the PBS.
And it could be funded using a health fund model or a capitation system involving an annual subscription.
The PBS is gradually contracting to high-priced specialty items and this trend is likely to accelerate.
An overall budget increase for PBS is not likely to appear, so we already have a drug rationing system.
A dispensing catalogue could also include nutritional supplement items as well as other complementary or herbal items.
Australians do prefer an integrated approach to their health issues.
Options for compounding of medicines should be increased in scope and formulation.

Note that the Skeptic/Big Pharma agenda is to eliminate all competition including natural and compounded drug formats, which is why they are targeted by Skeptic “stalkers”.
Have you ever wondered who pays the “stalker” expenses or supplements their income?

All the current attacks on community pharmacy, a trusted and highly respected health service delivery model, have nothing to do with patient benefit.
It’s early days and there is time to develop alternative counter-measures.
Perhaps the current threats will stimulate culture change generated through the conversion of innovation to workable systems.
Which is exactly why Amazon is able to position itself in the marketplace through internal innovation and research.
Pharmacy has matching abilities but not the dynamic leadership.
Time to move forward before we are dismembered.