7 ms·

I interviewed at Pillpack years ago and was very impressed but didn't get the gig. They seemed to be solving a great problem for customers using multiple medic

I interviewed at Pillpack years ago and was very impressed but didn't get the gig. They seemed to be solving a great problem for customers using multiple medicines. I am not sure the solution works well for the millions of us taking one pill every night, e.g the "pillpack" is wasteful. It also doesn't address this really annoying problem I have getting my daughter's ADD meds. These require a paper prescription that must be hand couriered to the local CVS. A giant PITA.

mikeatlas 8y ago
Similar story here, met them circa 2014/5. Their top target audience is seniors and elderly with several medications at different times of day. The baby-boomer generation will be around for a long time to support these kinds of Rx delivery mechanisms. I expect the other existing Rx delivery companies in the space to start doing daily-packs style in the future.
cabaalis 8y ago
I'm curious if you know why the ADD meds must be hand-delivered when government is actively incentivising e-prescribing among providers?
- mikeatlas 8y ago
  Controlled substance and cannot be prescribed more than 1mo supply at a time.
  - nickthegreek 8y ago
    It is a huge pain. Even if your prescriber gives you 3 prescriptions (1 month each, which I think is the maximum amount of time for a controlled substance in a single prescription), the entity that is fulfilling that order is not allowed to hold onto the other 2 for future fulfillment.
    - racecar789 8y ago
      Yeah the doc can put a "do not fill before [date]" and schedule scripts out for three months. Both CVS and Rite-Aid have an arcane system where controlled prescriptions are kept "offline". Their websites will not show the scripts as available to refill even if the doc has prescribed ahead of time. So one has to call to confirm the script was received, then call every month a refill is needed. But even worse...Rite-Aid requires a mandatory 30 day wait (per 30 day script). So that means on the day of refill...one needs to rush over early in the morning to get the refill, otherwise will risk missing a dose. CVS is a little better, allowing a 3-5 day early fill. But they also have their secret "offline" system for controlled substances. It's still a royal pain. So for Amazon...very little effort is required to succeed...simply show scripts that the doctor has sent over on their website...and offer a 2-5 day early fill....CVS/Rite-Aid won't stand a chance....
  - prepend 8y ago
    I thought controlled substances required eprescribing, but they aren’t per the DEA. They are allowed though. [0] It must just be some health systems require it as policy. [0] https://www.deadiversion.usdoj.gov/ecomm/e_rx/faq/faq.htm https://www.deadiversion.usdoj.gov/ecomm/e_rx/faq/faq.htm
  - always_good 8y ago
    I get a prescription for a 3 month supply of Vyvanse (amphetamine), 90 pills. The real pain is in the pharmacies who love to power trip. The CVS near me got a new pharmacist who decided she didn't want to fill my prescription because I wanted to pay in cash (no insurance at the time). Didn't even offer to call up my doctor's office to confirm. Just a hard no and goodbye. Made me feel awful, like I was trying to cheat the system or something by paying the ridiculous retail price of $850 for a drug that cost me $20 when I had insurance. Had to go across the road to Walgreens who never let me down. What a hilariously stupid system we have making everyone feel like a criminal. I get anxiety all day when it's time to refill. A drug I've been taking for 10 years.
    - supertrope 8y ago
      To get what you want, you must first understand the perspective of others. Understand their motivations and incentives and then take the path of least resistance. Apparently pharmacists can be held personally liable for narcotic law violations. When you pay in cash instead of with an insurance claim you are not in the system. Not all cash payers are trouble, but a noticeably higher proportion of cash payers are trouble. The same goes for being a new patient/customer, saying you lost your bottle, or needing an early refill. Assholes who re-sell their methylphenidate are why DEA, docs, pharmacies, etc. are putting up barriers. As you noted this can be hostile to the people who need to take their meds. You can get stuck in a vicious cycle where being in urgent need is interpreted as suspicious which leads to denials and lack of meds makes you more harried. It's worst for people who are physically dependent on their meds and will who go into withdrawl, pain, or become very unproductive.
      - melq 8y ago
        I've had similar experiences to OP, and I can also attest to the fact that it is absolutely obnoxious to be treated like a criminal in the normal course of filling your daily prescription. Sometimes you have to travel for work, and because methylphenidate is such a threat to society (it isn't) you can't fill prescriptions out of state. So you talk to your doctor to get a special prescription with written instructions to allow it to be filled 4 days early (gasp!) so you can fill it before your trip. The pharmacist then rejects filling it for you, for reasons they refuse to explain. I see a doctor in my home state, about an hour's drive from where I currently live. I see this doctor once every three months. I've seen him for 10 years. I would like to continue to see him. Recently I was put on a light sleep aid for anxiety reasons, I went to fill this prescription (which I have to do in the state that I see the doctor in). I was told my insurance only allows me to get a 2 week supply, and I'll have to come back in 2 weeks later to fill the rest of the 30 day prescription the doctor wrote. When I asked how much it would cost to just pay out of pocket, it was negligable, 20 dollars or so. When I asked to just pay for it myself to avoid making a long trip again 2 weeks later, the pharmacist decided to deny giving me anything.
snissn 8y ago
> for the millions of us taking one pill every night, e.g the "pillpack" is wasteful. Does the pillpack have a separate pack for each day with the date clearly labeled? If so I feel that would help a lot with adherence, which in my opinion is a serious problem
- wjp3 8y ago
  It does. The only problem is getting more granular - if you have a medication that is administered throughout a day, you'll have to handle that yourself.
  - rickster88 8y ago
    That's not exactly true, if you take medications at different times during the day you'll have multiple packs for a single day marked with the time of day.
    - wjp3 8y ago
      Ok, that's an improvement since I was with them, then. Good to know.
dingaling 8y ago
> They seemed to be solving a great problem for customers using multiple medicines. Most high-street pharmacies in the UK have offered pill-packs for years; you route all your prescriptions to them and their pharmacists arrange the medication into little time-inscribed compartments on a blisterpack. For them there is benefit in monopolising the medicines of each customer ( more $$ from the NHS ) and for the customer it becomes simple to take medicine at the correct times and intervals. For relatives it's also simple to check that medicines have been taken as required. PillPack seems to do that, but 'on the Internet'. shrug
- melq 8y ago
  >Most high-street pharmacies in the UK >PillPack seems to do that, but 'on the Internet'. shrug Leaving aside the fact that 'on the internet' is a huge and important distinction (you should check out this company Uber, it's like a taxi but 'on the internet'), you seem to be saying "there's this great service available to us here in the UK, I can't imagine why a company in the US would want to replicate it shrug."
md224 8y ago
That’s weird... I live in NYC and get my Vyvanse prescription delivered by Capsule. Haven’t had to drop off a paper prescription in years. Different local laws? Or maybe it’s because she’s a minor? That sounds frustrating, sorry you have to deal with that. P.S. While we’re on the topic, if anyone’s interested in a libertarian perspective, check out Jessica Flanigan’s 2012 JME paper “Three arguments against prescription requirements”: https://jme.bmj.com/content/38/10/579 https://jme.bmj.com/content/38/10/579
- PeanutNore 8y ago
  Likely it's due to the Controlled Substances Act - one of the most common ADHD medications, Adderall, is schedule 2 or schedule 3. Electronic prescribing for controlled substances (EPCS) has strict requirements and your local pharmacy or your physician may not yet be certified.
  - md224 8y ago
    Right, but Vyvanse (lisdexamfetamine) is also a Schedule II ADHD medication, hence my surprise that this person has to jump through more hoops than I do. You have a point about certification, though... perhaps less populous areas don’t have these advanced systems in place.
    - harshaw 8y ago
      hmm, that's really interesting. She's on Vyvanse. I'm in MA.
- elahd 8y ago
  With a few exceptions, paper prescriptions have been outlawed in New York State. Everything is electronic now.
  - supertrope 8y ago
    Finally. No more important artifact that can be lost, forged, or written on with horrible handwriting. Phoning home to a database is much harder to fake than a paper document with security features like watermark, hologram, microprinting, etc. Is this even for schedule II meds? As a bonus, the pharmacy team usually has the meds ready by the time I arrive instead of needing to make a second visit or waiting after handing off the slip.
deleted 8y ago
[deleted]
lkjlaksjdflk 8y ago
I feel for you dads that have to wait in CVS/Walgreens. Hopefully the system gets easier for you guys. Maybe your doctors office could setup eRx but that does require certain software/money.

mikeatlas 8y ago

Similar story here, met them circa 2014/5. Their top target audience is seniors and elderly with several medications at different times of day. The baby-boomer generation will be around for a long time to support these kinds of Rx delivery mechanisms. I expect the other existing Rx delivery companies in the space to start doing daily-packs style in the future.

cabaalis 8y ago

I'm curious if you know why the ADD meds must be hand-delivered when government is actively incentivising e-prescribing among providers?

mikeatlas 8y ago
Controlled substance and cannot be prescribed more than 1mo supply at a time.
- nickthegreek 8y ago
  It is a huge pain. Even if your prescriber gives you 3 prescriptions (1 month each, which I think is the maximum amount of time for a controlled substance in a single prescription), the entity that is fulfilling that order is not allowed to hold onto the other 2 for future fulfillment.
  - racecar789 8y ago
    Yeah the doc can put a "do not fill before [date]" and schedule scripts out for three months. Both CVS and Rite-Aid have an arcane system where controlled prescriptions are kept "offline". Their websites will not show the scripts as available to refill even if the doc has prescribed ahead of time. So one has to call to confirm the script was received, then call every month a refill is needed. But even worse...Rite-Aid requires a mandatory 30 day wait (per 30 day script). So that means on the day of refill...one needs to rush over early in the morning to get the refill, otherwise will risk missing a dose. CVS is a little better, allowing a 3-5 day early fill. But they also have their secret "offline" system for controlled substances. It's still a royal pain. So for Amazon...very little effort is required to succeed...simply show scripts that the doctor has sent over on their website...and offer a 2-5 day early fill....CVS/Rite-Aid won't stand a chance....
- prepend 8y ago
  I thought controlled substances required eprescribing, but they aren’t per the DEA. They are allowed though. [0] It must just be some health systems require it as policy. [0] https://www.deadiversion.usdoj.gov/ecomm/e_rx/faq/faq.htm https://www.deadiversion.usdoj.gov/ecomm/e_rx/faq/faq.htm
- always_good 8y ago
  I get a prescription for a 3 month supply of Vyvanse (amphetamine), 90 pills. The real pain is in the pharmacies who love to power trip. The CVS near me got a new pharmacist who decided she didn't want to fill my prescription because I wanted to pay in cash (no insurance at the time). Didn't even offer to call up my doctor's office to confirm. Just a hard no and goodbye. Made me feel awful, like I was trying to cheat the system or something by paying the ridiculous retail price of $850 for a drug that cost me $20 when I had insurance. Had to go across the road to Walgreens who never let me down. What a hilariously stupid system we have making everyone feel like a criminal. I get anxiety all day when it's time to refill. A drug I've been taking for 10 years.
  - supertrope 8y ago
    To get what you want, you must first understand the perspective of others. Understand their motivations and incentives and then take the path of least resistance. Apparently pharmacists can be held personally liable for narcotic law violations. When you pay in cash instead of with an insurance claim you are not in the system. Not all cash payers are trouble, but a noticeably higher proportion of cash payers are trouble. The same goes for being a new patient/customer, saying you lost your bottle, or needing an early refill. Assholes who re-sell their methylphenidate are why DEA, docs, pharmacies, etc. are putting up barriers. As you noted this can be hostile to the people who need to take their meds. You can get stuck in a vicious cycle where being in urgent need is interpreted as suspicious which leads to denials and lack of meds makes you more harried. It's worst for people who are physically dependent on their meds and will who go into withdrawl, pain, or become very unproductive.
    - melq 8y ago
      I've had similar experiences to OP, and I can also attest to the fact that it is absolutely obnoxious to be treated like a criminal in the normal course of filling your daily prescription. Sometimes you have to travel for work, and because methylphenidate is such a threat to society (it isn't) you can't fill prescriptions out of state. So you talk to your doctor to get a special prescription with written instructions to allow it to be filled 4 days early (gasp!) so you can fill it before your trip. The pharmacist then rejects filling it for you, for reasons they refuse to explain. I see a doctor in my home state, about an hour's drive from where I currently live. I see this doctor once every three months. I've seen him for 10 years. I would like to continue to see him. Recently I was put on a light sleep aid for anxiety reasons, I went to fill this prescription (which I have to do in the state that I see the doctor in). I was told my insurance only allows me to get a 2 week supply, and I'll have to come back in 2 weeks later to fill the rest of the 30 day prescription the doctor wrote. When I asked how much it would cost to just pay out of pocket, it was negligable, 20 dollars or so. When I asked to just pay for it myself to avoid making a long trip again 2 weeks later, the pharmacist decided to deny giving me anything.

snissn 8y ago

> for the millions of us taking one pill every night, e.g the "pillpack" is wasteful. Does the pillpack have a separate pack for each day with the date clearly labeled? If so I feel that would help a lot with adherence, which in my opinion is a serious problem

wjp3 8y ago
It does. The only problem is getting more granular - if you have a medication that is administered throughout a day, you'll have to handle that yourself.
- rickster88 8y ago
  That's not exactly true, if you take medications at different times during the day you'll have multiple packs for a single day marked with the time of day.
  - wjp3 8y ago
    Ok, that's an improvement since I was with them, then. Good to know.

dingaling 8y ago

> They seemed to be solving a great problem for customers using multiple medicines. Most high-street pharmacies in the UK have offered pill-packs for years; you route all your prescriptions to them and their pharmacists arrange the medication into little time-inscribed compartments on a blisterpack. For them there is benefit in monopolising the medicines of each customer ( more $$ from the NHS ) and for the customer it becomes simple to take medicine at the correct times and intervals. For relatives it's also simple to check that medicines have been taken as required. PillPack seems to do that, but 'on the Internet'. shrug

melq 8y ago
>Most high-street pharmacies in the UK >PillPack seems to do that, but 'on the Internet'. shrug Leaving aside the fact that 'on the internet' is a huge and important distinction (you should check out this company Uber, it's like a taxi but 'on the internet'), you seem to be saying "there's this great service available to us here in the UK, I can't imagine why a company in the US would want to replicate it shrug."

md224 8y ago

That’s weird... I live in NYC and get my Vyvanse prescription delivered by Capsule. Haven’t had to drop off a paper prescription in years. Different local laws? Or maybe it’s because she’s a minor? That sounds frustrating, sorry you have to deal with that. P.S. While we’re on the topic, if anyone’s interested in a libertarian perspective, check out Jessica Flanigan’s 2012 JME paper “Three arguments against prescription requirements”: https://jme.bmj.com/content/38/10/579 https://jme.bmj.com/content/38/10/579

PeanutNore 8y ago
Likely it's due to the Controlled Substances Act - one of the most common ADHD medications, Adderall, is schedule 2 or schedule 3. Electronic prescribing for controlled substances (EPCS) has strict requirements and your local pharmacy or your physician may not yet be certified.
- md224 8y ago
  Right, but Vyvanse (lisdexamfetamine) is also a Schedule II ADHD medication, hence my surprise that this person has to jump through more hoops than I do. You have a point about certification, though... perhaps less populous areas don’t have these advanced systems in place.
  - harshaw 8y ago
    hmm, that's really interesting. She's on Vyvanse. I'm in MA.
elahd 8y ago
With a few exceptions, paper prescriptions have been outlawed in New York State. Everything is electronic now.
- supertrope 8y ago
  Finally. No more important artifact that can be lost, forged, or written on with horrible handwriting. Phoning home to a database is much harder to fake than a paper document with security features like watermark, hologram, microprinting, etc. Is this even for schedule II meds? As a bonus, the pharmacy team usually has the meds ready by the time I arrive instead of needing to make a second visit or waiting after handing off the slip.

deleted 8y ago

[deleted]

lkjlaksjdflk 8y ago

I feel for you dads that have to wait in CVS/Walgreens. Hopefully the system gets easier for you guys. Maybe your doctors office could setup eRx but that does require certain software/money.