November 24, 2020
The press reported in mass about the launch of Amazon’s online pharmacy. This new service will deliver greater convenience and lead to more competition on drug pricing.1-6 There is little doubt that Amazon’s launch into pharmacy delivery services will change drug distribution, potentially forever. However, does this widely anticipated, very public, launch improve health care for the average US citizen?
Will Amazon’s new service reduce medication errors that contribute to substantial morbidity and mortality in the US? Probably not. Drug-related error rate is a major health care crisis.7-9 The annual estimated cost of drug-related morbidity and mortality resulting from non-optimization of medication therapy is $528.4 billion (range $495.3 to $672.7 billion).8 This estimated annual cost is equivalent to 16% of total U.S. health care expenditures in 2016. The average drug-related morbidity and mortality cost was $2481/event (range: $2233 to $2742).8 Amazon customers can communicate with pharmacy personnel 24/7. However, it is up to the customer to initiate this conversation. How does a customer have the ability to know that a potential medication error may occur? They do not.
Amazon claims they will screen for potential problematic drug interactions for customers who are taking multiple medications at once. This is laudatory, but the health care system has claimed this service for years. Yet, drug errors continue to escalate, injuring an estimated 1.5 million persons yearly.10 Pharmacists working with physicians can influence this crisis in a very positive manner. Medication errors include choosing the incorrect medication after typing in the first letters of the drug name, choosing an incorrect frequency, filling the prescription inaccurately, or the patient not taking the medication as prescribed. The Amazon service does not appear to affect any of these poor outcomes. The pharmacy profession calls on Amazon to prove, in short order, that they actually can affect this major health care crisis.
Will Amazon’s service improve medication adherence? Possibly. By improving convenience and potentially more competition in drug pricing, medication adherence can be improved.11 Amazon’s promise of greater home delivery with shorter turnaround times in more markets may improve medication adherence.12 However, this promise could easily become a major problem if many local community pharmacies close because of their inability to compete with Amazon, thereby actually exacerbating the medication adherence problem. This issue should be followed closely by the health care industry.
The loss of community pharmacies that may occur from Amazon’s launch into drug distribution may have profound health care ramifications. It is clear that structural inequality limits quality health care in the U.S.13 Social and environmental factors likely play a critical role in limiting health care access leading to poorer quality. Community pharmacies are a mainstay in delivering health care in some of these communities. Further loss of community pharmacies will not improve racial health care inequality, and may, in fact, exacerbate this structural problem.
Prescribing inertia in many diseases remains a significant problem across the world.14-16 Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started.16 Amazon’s new service will not affect prescribing inertia.
Finally, waste in the US health care system ranges between $760-935 billion dollars or approximately 25% of total health care spending.17 The impact of this effect is related to failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse, and administrative complexity,16 Amazon’s new prescription will not affect this US health care expenditure problem.
Therefore, before the US health care system welcomes Amazon’s new service with open arms,18 we should consider all of the drug use processes that are involved in providing excellent pharmaceutical care to the patient, not just drug distribution.
Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy.
Disclaimer: The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of Population Health Learning Network. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.
- Amazon opens online pharmacy shaking up another industry. https://apnews.com/article/amazon-opens-online-pharmacy-ebebe13bef54220ec3b0c7ffdcda2a68 Accessed 11/2020
- Amazon wants to sell you prescriptions. https://www.npr.org/2020/11/17/935727688/amazon-wants-to-sell-you-prescription-medications Accessed 11/2020
- Amazon unveils online pharmacy. https://thehill.com/homenews/news/526273-amazon-unveils-online-pharmacy Accessed 11/2020
- Amazon expands push into health care with online pharmacy. https://www.bloomberg.com/news/articles/2020-11-17/amazon-expands-push-into-health-care-with-online-pharmacy Accessed 11/2020
- Amazon launches new online pharmacy in new contest with drug retail. https://www.reuters.com/article/amazoncom-pharmacy/update-1-amazon-launches-online-pharmacy-in-new-contest-with-drug-retail-idUSL1N2I30WA Accessed 11/2020
- Amazon launches online pharmacy. https://www.wsj.com/articles/amazon-com-adds-prescription-medicine-options-to-its-site-11605613679 Accessed 11/2020
- To Err is Human: Errors in Health Care – A Leading Cause of Death and Injury. https://www.ncbi.nlm.nih.gov/books/NBK225187/ Accessed 03/2020
- Watanabe JH, et al. The cost of prescription drug-related morbidity and mortality Ann Pharmacother 2018;52(9);829-837.
- Assiri GA, et al. What is the epidemiology of medication errors, erro-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of international literature. BMJ Open 2018;8:e019101
- Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually; Report Offers Comprehensive Strategies for Reducing Drug-Related Mistakes. Accessed 11/2020
- Prescription Drug Price Transparency and its Visible Impact on Medication Adherence. https://drfirst.com/resources/blog/prescription-drug-price-transparency-and-its-visible-impact-on-medication-adherence/ Accessed 11/2020
- Amazon Pharmacy not likely to disrupt drug fulfillment. https://www.modernhealthcare.com/supply-chain/amazon-pharmacy-not-likely-disrupt-drug-fulfillment?utm_source=modern-healthcare-am-wednesday Accessed 11/2020
- Williams DR, Cooper LA. COVID-19 and health equity—a new kind of “herd immunity”. JAMA 2020;323(24):2478-80.
- Roumie CL, Elasy TA, Wallston KA, Pratt S, Greevy RA, Liu X, Alvarez V, Dittus RS, Speroff T. Clinical inertia: a common barrier to changing provider prescribing behavior. Jt Comm J Qual Patient Saf. 2007 May;33(5):277-85. doi: 10.1016/s1553-7250(07)33032-8. PMID: 17503683.
- Experts tout immediate quadruple therapy for HfrEF patients. https://www.medscape.com/viewarticle/939465?src=soc_tw_201022_mscpedt_news_tho_hf&faf=1 Accessed 11/2020
- Steinman MA, Landefeld CS. Overcoming Inertia to Improve Medication Use and Deprescribing. JAMA. 2018;320(18):1867-1869. doi:10.1001/jama.2018.16473
- Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978
- Pharma CEOs welcome Amazon to disrupt drug distribution. https://www.cnbc.com/2017/11/01/pharma-ceos-welcome-amazon-to-disrupt-drug-distribution.html Accessed 11/2020