If Amazon’s move to disrupt health care is going to make Americans any healthier, the improvement is most likely to take place in the business of getting prescription drugs to patients more reliably. For one thing, there’s plenty of room for improvement. Failure to take prescription drugs kills about 125,000 Americans a year, according to a recent review in the Annals of Internal Medicine, and this form of noncompliance costs the health care system $100 billion to $289 billion a year.
PillPack -- the online pharmacy service that Amazon bought this week -- already simplifies health care for its customers by pre-sorting multiple prescriptions. Amazon could do even more by cutting down on the 20 to 30 percent of prescriptions that are reportedly never filled, easing communications between doctors and patients, and helping the medical community collect useful data on side effects and customer satisfaction.

Physician and Harvard Medical School health policy professor Anupam Bapu Jena said he’s skeptical about Amazon’s ability to change the quality of doctor visits or hospital stays, but in prescription drugs, he can envision a number of big changes that would benefit patients.

There are two forms of noncompliance, he said. Some people get prescriptions filled but fail to take them, which is hard for Amazon to address. But many patients never fill the prescriptions at all, and here, Amazon could take away that step. Drugs would automatically arrive at patients’ homes.

Jena said there are a number of reasons people fail to take medications. One big factor he sees is that people are taking drugs to prevent illness, or to prevent complications from diabetes, asthma or other conditions. Because these drugs often don’t make patients feel better on a day-to-day basis, they are easy to forget or skip. It’s not like taking antibiotics or pain medications for a painful infection.

Cost is another factor. He considers this a minor effect. In one study, he said, researchers divided heart patients into two groups, one of which was charged the ordinary price for a prescription drug, while to the other got the drug for free. Free drugs improved compliance, he said, but only a little, moving it from around 50 percent to around 55 percent.

But in a broader survey done by the Commonwealth Fund, a third of Americans over 65 said they’d either skipped going to the doctor when sick or failed to fill prescriptions because they couldn’t afford the out-of-pocket costs. Because Amazon could function as a large buyer, Jena said, it might be possible for the company to negotiate lower drug prices from manufacturers.

My Bloomberg Opinion colleague Stephen L. Carter pointed out this week that access, affordability or both seem to contribute to compliance: “Living near a Walmart pharmacy significantly increases the likelihood that someone suffering from high blood pressure will take medication and decreases avoidable hospitalizations by a remarkable 6.2 percent.”

Jena sees even more potential in the world of data. In the future, patients could log into their Amazon accounts to track their prescription history, helping them better track their own health care. The company could also offer something like the “you might also like” recommendation engine, but more based on science than browsing history. A patient might indicate he has coronary heart disease and high cholesterol, for example. Amazon would also have data on the patient’s meds, and could recommend alternative treatments. Or Amazon might inform doctors that similar patients are getting a higher dose of the same drug.

Amazon would also have the capacity to collect data on side effects. Clinical trials are not big enough or run over a long enough time period to catch the less common side effects. Those tend to be identified after drugs go on the market and are widely used. But they might be identified faster if patients reported side effects the same way they write reviews of products. Not all reported complaints will be attributable to the drugs, but with enough data, patterns would emerge.

In the same way, and by tracking health outcomes, Amazon could also collect much-needed data on dangerous drug interactions -- hazards that wouldn’t necessarily have been revealed in clinical trials. The more patients and their doctors know about side effects and interactions, the more likely patients will be to get the right prescription for their needs and the lower the risk of noncompliance.

And finally, Amazon’s online pharmacy can ask you about your experience the same way Amazon asks people how they liked the disposable diapers or cat food they ordered. People could report whether they finished a prescription, and if not, could check boxes to indicate the reason -- whether it was related to cost, or side effects, or forgetfulness, or the perception that the drug wasn’t helping. An Amazon online pharmacy could transfer a lot of the power and responsibility of improving health care to patients themselves. Which is fine, because we’re the ones whose lives depend on it.


Faye Flam
Faye Flam is a Bloomberg Opinion columnist. -- Ed.

(Bloomberg)