By: Caitlyn Cummings, Pharm.D. and Maria Marzella Mantione, Pharm.D., CGP, FAPhA
–
From ordering food to requesting transportation, we trust app-based delivery services for everything, so it makes sense that medication delivery through an app would be next. Zipdrug is a new medication delivery service based in New York City which will pick-up and deliver prescriptions from a desired pharmacy in Manhattan as well as in parts of Brooklyn and Queens. But what does this mean for pharmacists? And how can we trust a service with something as sensitive as a patient’s medications? As health care professionals, we need to adapt to the ever-changing world of medicine, but not without addressing important concerns first.
Although Zipdrug has no affiliation with any pharmacy, they have recently partnered with CityMD Urgent Care in Manhattan. Kiosks will begin to be available at these urgent care centers so that patients will be spared a trip to the pharmacy.1 The “one-stop shopping” idea will especially be enticing to sick patients or parents with children who are unable to wait at the pharmacy.
Patients do not have to use CityMD to use Zipdrug’s delivery service. Through the Zipdrug app, over the phone, or online, patients supply their information including: name, address, telephone number, email address, pharmacy name and address, a picture of their insurance card, and credit card information. Patients can make a request to Zipdrug after requesting a refill at their pharmacy or after their provider sends an electronic prescription to the pharmacy of their choice. However, the service does not apply to prescriptions for controlled substances. The first delivery is free and the cost thereafter is $10 for the delivery service plus the cost of the medication(s).1,2
News outlets are claiming that Zipdrug will provide “greater medication adherence.”2 Although it is too soon to tell, this company definitely has the potential to help with primary nonadherence, which is when a new prescription is never picked up. An Annals of Internal Medicine study conducted in 2011 found that nearly one-third of all prescriptions written remain unfilled. However, the rationale for patients not filling their prescriptions could not be quantified.3 The reasons for medication nonadherence are multifaceted and are specific for each patient. Zipdrug advertises that they will improve medication adherence by doing the work for the patient and getting the medications into their hands.
Not all pharmacies can offer delivery services especially in large cities, and as health care professionals, we cannot deny that this service is often needed for patients for various reasons. Because medication nonadherence is such a problem in the U.S., costing upwards of $100 billion each year, the benefits that Zipdrug can offer should not be immediately dismissed.4 Having a third-party provide a delivery service may, in fact, improve primary medication adherence for many patients. From the pharmacist’s perspective however, the service raises some questions.
What challenges does Zipdrug pose for pharmacists?
1) Trusting the Zipdrug messenger: Under HIPAA, it is acceptable for the pharmacist to dispense the medication to the messenger since they are authorized to do so by the patient. The patient (or a third party authorized by the patient) voluntarily submits personal information to Zipdrug. What is comforting for pharmacists and patients to know is that all the messengers are HIPAA-trained, drug-screened, background-checked, and have passed a test before starting.1 Through the app, patients can track the delivery in real-time, much like Domino’s® or Uber®, and must sign for their medication upon arrival.1 As with any delivery service, it is unlikely for the patient to know the deliveryman personally and therefore, a certain amount of trust must go into using Zipdrug. In this way, having them deliver a patient’s prescriptions shouldn’t be too much different than having a pharmacy delivery person send them.
2) Counseling the patient effectively: A pharmacist may not know that a Zipdrug representative is picking up the prescription on the patient’s behalf. This makes a proper plan for counseling the patient difficult. Does the Zipdrug driver have the authority to deny counseling on the patient’s behalf? Or will the pharmacist go out of their way to call and counsel the patient if it is a new medication? Zipdrug acknowledges that their messengers are not health care professionals and that any questions that the patient may have should be directed to their pharmacist.1
3) Confusion for the patient or pharmacist: Confusion can come about when the medication is not in stock, not on the patient’s formulary, or is different from what the patient expected. The patient may also have a higher than expected copayment or may end up wasting money on Zipdrug without receiving the medication (for example, if the medication needs a prior authorization). If the pharmacist does not inform the patient before Zipdrug delivers the medication to the patient’s home, confusion and frustration can be compounded. In addition, once the prescription leaves the pharmacy, the pharmacist cannot take it back. Therefore, effective communication between the pharmacist and patient is the key to handling these problems directly or avoiding them altogether.
4) Zipdrug’s advertising: The phrase “Stop wasting time waiting at the pharmacy” can be found on the homepage of Zipdrug.1 People wait for their food to be cooked at restaurants, for the oil in the car to be changed, to see their doctors, etc., so why is waiting in a pharmacy portrayed as a waste of time? In fact, pharmacy wait times are more of a safety issue rather than an inconvenience. Pharmacists have the responsibility to ensure that the patient is receiving the correct medication at the correct dose and schedule and in doing so, they sometimes have to call the doctor to make a recommendation or change the medication based on the patient’s insurance coverage. Additionally, they have to check for allergies or drug interactions, prepare the medication, as well as be available to counsel and answer questions from other patients. All of these things need to be factored into why the patient is waiting. Also, when the prescriber electronically submits the prescription, it does not automatically appear in the pharmacy’s computer system as it first goes through a transaction hub.
Another term that Zipdrug uses to advertise is “hours wasted at the pharmacy everyday,” wherein Zipdrug claims to be 8,219,178 hours.1 This is a very bold claim, possibly even inflated, especially due to the fact that there is no source to back it up. Again, the concept of wasting time at a pharmacy is demeaning to the profession as rapport with the pharmacist could potentially save patients lives. If the company wants support from pharmacies, the company should be making valuable connections with pharmacies and not be putting them in a bad light.
As this new third party is introduced into the equation of patient care, it is important as health care professionals to determine what challenges this brings up for us and our patients as well as how we are going to respond. Sure we can simply dismiss this company, or we can see its value for our patients. Zipdrug is definitely going to be an enticing service for many individuals and it is up to us to decide how we are going to adapt to this new entity involved in patient care.
SOURCES:
- Frequently asked questions. Zipdrug. https://www.zipdrug.com/faq. Accessed: 01/20/2016.
- PR Newswire. Zipdrug and cityMD partner to revolutionize prescription delivery for millions of new yorkers. Available at: http://www.thestreet.com/story/13416010/1/zipdrug-and-citymd-partner-to-revolutionize-prescription-delivery-for-millions-of-new-yorkers.html. 01/7/2016.
- Tamblyn R, Eguale T, Huang A, Winslade N, Doran P. The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study. Ann Intern Med. 2014;160(7):441-50.
- Vermeire E, Wens J, Van Royen P, et al. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;(2):CD003638.
