February 06, 2005

Drug Kiosks in California

A Marin pharmacists group is challenging a push by two major drug and supermarket chains to add ATM-like drug-refill dispensers in their stores.

ATM-style drug kiosks spark debate

By Keri Brenner, IJ reporter

A Marin pharmacists group is challenging a push by two major drug and supermarket chains to add ATM-like drug-refill dispensers in their stores.

However, consumer response so far to one test model in Southern California has been "overwhelming," according to Linda Tinney, founder of Del Mar-based Asteres Inc., which makes the device.

"We had more than 500 people sign up for the service in one month," Tinney said, adding that most customers want to pick up "lifestyle drugs" they take every month, such as Viagra, thyroid pills, allergy medications or hormones. "They don't want to stand in line to get their birth control."

Fred Mayer of San Rafael, president of the nonprofit Pharmacy Defense Fund of San Rafael, said the prescription drug kiosks being tested by Walnut Creek-based Longs Drug Stores could be a problem if people use them after the pharmacy closes.

"It's a safety hazard," said Mayer, a past president of the Marin County Pharmacists Association, explaining that no one would be available to check for potential labeling errors, symptoms, side effects, drug interactions or other problems. "Pharmacists shouldn't be trained for eight years to stick something in a kiosk."

Both Longs and Pleasanton-based Safeway Inc. have waivers from the California State Board of Pharmacy to test and install the devices at their drug and grocery stores, said Patricia Harris, the state board's executive officer.

The machines, made by Del Mar-based Asteres, Inc., would work by holding prescriptions that already have been filled by store pharmacists until a customer is ready to pick them up. The customer would need a personal identification number (PIN) or card to access the machine, which could be available around the clock for stores that are open 24 hours.

"We see it as an added convenience for our customers, who will be able to pick up a prescription when the pharmacy is closed," Safeway spokeswoman Jennifer Webber said. "It's not a dispenser, it's a delivery machine - it delivers prescriptions that have been filled by our pharmacists."

Longs officials say the kiosk is one of many improvements the company is looking at to allow pharmacists more time with customers, not less. By automating the most routine functions, pharmacists would be better able to spend time with customers who have questions, Longs spokeswoman Phyllis Proffer said.

"Obviously, the heart of our business is our pharmacy," she said. "We would consider the pharmacists to have a major role in drug therapy, and we would do everything we can to promote interaction between the pharmacist and the customer/patient."

Proffer said she did not know if the devices would be installed at stores other than the one in Southern California. Harris said the one Longs test site is at a store in Del Mar; Safeway has not yet set up any test stores, she said.

The Pharmacy Defense Fund, a group Mayer formed to fight legal issues of concern to pharmacists, last week sent a letter to Harris criticizing the waivers' alleged lack of specific details on issues such as security of the machines, proximity to pharmacists, notification to customers about counseling and the potential for consumers to violate the refills-only policy.

Jeff Moss of San Rafael, attorney for the Pharmacy Defense Fund, contends in his letter to the state board that the Longs waiver, issued Dec. 6, is "hardly a pilot program" and "appears to be a blanket waiver to allow Longs to install devices in all of its California stores."

Longs has 472 stores, 393 of which are in California, according to Proffer. Safeway has 1,815 stores in the United States and Canada.

But Tinney said the machine's design and operation addresses all of Moss's concerns - even if the language in the state board waiver might not spell it out.

"It's clear that they haven't talked to our vice president of pharmacy," Tinney said. "All their requirements are addressed in the technology."

Harris said she will forward Moss' letter to the pharmacy board when it meets in April. The board is considering approval of a new regulation to allow the devices without a waiver, she said.

"These are for refill prescriptions only," Harris said. "I'm sure if there are any problems, we'll hear from consumers - so far we haven't heard of any."

She said she "doesn't know who said it's a pilot program," because the Longs and Safeway waivers allow for installing the dispensers at any or all of the companies' stores. However, Harris added, the state board can rescind the waivers at any time.

"This is just an option consumers can use," she said.

Retired Kaiser Permanente pharmacist Phil Grauss of Novato said the waiver was "very ambiguous" because it doesn't have enough safeguards to guarantee that the right person is getting the right prescription.

Grauss, president of the Marin County Pharmacists Association, said during his 33-year career with Kaiser, clerks were required - at the minimum - to check the labels and identifications for even routine drug refills before handing the bag of drugs to the patients.

"What if there's a problem, what if there's an error - someone's getting dizzy and has some questions?" Grauss said. "The one-on-one, face-to-face with a pharmacist isn't going to happen."

Grauss added that he saw the issue as a financial one rather than something that improves customer service. If a machine can deliver the prescriptions, he said, there is less need for clerks or pharmacists to staff the operation.

"Ultimately, it's about money," he said. "It's always got an economic attachment or they wouldn't bother doing it."

Posted by Craig at February 6, 2005 11:37 PM