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‘Uber’ of Pharmacy: Disrupting the Market, or Patient Care?

Capsule, a digital pharmacy armed with a fleet of couriers that delivers prescriptions directly to patients’ doors, has been described as the Uber of pharmacy, but some patients have raised concerns about delays and missing medications.

The app-based pharmacy delivers same-day prescriptions in four of New York’s five boroughs (Staten Island excluded). The company describes itself as “anything but a chain type of pharmacy,” and offers text and call services with a real pharmacist — i.e., not a chatbot — on demand.

While Capsule touts efficiency and convenience and has garnered many positive reviews on social media, some customers say it hasn’t yet revolutionized their pharmacy experience.

Elizabeth Salzer, a physician assistant, began using Capsule as both a patient and a prescriber in 2016. Her wife was in and out of surgery, and she was taking losartan, an antihypertensive, and narcotics for pain management. Initially, Salzer said, frequent texts and phone calls with Capsule pharmacists, as well as home delivery, made getting prescriptions for herself and her wife seamless.

But as she continued using the service, Salzer noticed mistakes. “Things started getting a little squirrely,” she said in an interview with MedPage Today. “We were expecting delivery and delivery never occurred.”

On some occasions, it was after midnight when medications arrived at Salzer’s door. One delivery took more than six days, without an explanation from the company. In another instance, Salzer said, she received an extra bottle of oxycodone.

“I did not feel like this was good care, that’s for sure,” Salzer said.

Salzer is one of several patients who have reported long wait times, unresponsive staff, and incorrect doses of medication when using Capsule’s services. The tech startup has raised more than $200 million from investors and has plans to expand to other major U.S. cities, but customers have questioned whether the complaints hint at growing pains.

Eric Kinariwala, the CEO and founder of Capsule, created the app to make the pharmacy experience more efficient. After a sinus infection led him to an hour-long wait for a Z-Pak in the basement of his local Duane Reade (a pharmacy chain in New York, now owned by Walgreens) — only to leave without antibiotics — Kinariwala was inspired to make getting prescriptions faster and easier, potentially disrupting the pharmacy market the way Uber and Lyft did for taxi services, he told the New York Times.

Here’s how it works: patients request to transfer their prescriptions to Capsule, schedule a same-day delivery time, and wait for a courier to deliver medication to their door via bike, subway, or other mode of public transit, all within 2 hours and free of charge.

Capsule operates a brick-and-mortar pharmacy in midtown Manhattan, a short walk from the Empire State Building. The storefront looks like a laboratory: it’s all white, lined with shelves of medication bottles and boxes of pills. Behind a spotless front desk, the location’s open layout reveals rows of pharmacists quickly filling prescriptions to hand off to the couriers waiting outside the front entrance, which still sports window coverings put up by the renovation contractor.

Customers can pick up prescriptions at Capsule’s location in midtown Manhattan, still apparently a work in progress. Photo by Amanda D’Ambrosio

Capsule told Bloomberg it has 60,000 patients, and has about 260 employees and works with more than 30 pharmacists, according to the New York Times. Its ads have become ubiquitous in New York City, appearing on taxis, subways, and buildings citywide. Kinariwala told Bloomberg he plans to grow the business to “all of the major cities” within the next three years

Capsule ads are ubiquitous in New York: on subways, in taxis, and on buildings throughout the city. Photo by Amanda D’Ambrosio

Capsule is not the only digital pharmacy startup in the national market, however. Chain pharmacies such as CVS and Walgreens compete by offering their own delivery services. PillPack, a startup acquired by Amazon in June 2018, delivers individually packaged prescription drugs by mail.

San Francisco-based pharmacy startup Alto has a business model most similar to Capsule’s. Alto’s pharmacy offers on-demand text and call services with pharmacists and home deliveries by couriers. The company delivers prescription drugs in California, Nevada, Washington, and Colorado. Alto has also attracted investors, raising about $250 million from Soft Bank’s Vision Fund 2 in January, according to CNBC.

Like Capsule, Alto has many positive reviews, but the negative ones raised similar concerns about long wait times for prescriptions, poor customer service, and even app glitches.

One of Capsule’s customers reported having to wait more than three weeks for anxiety medication. The patient, who spoke with MedPage Today on the condition of anonymity, started using Capsule after seeing an ad on the subway for free home delivery. She said the wait for medication caused her to have an anxiety attack for the first time in months.

Other patients have reported receiving incorrect doses of their prescriptions. One Yelp reviewer stated that she received a package with several missing pills, all of which were controlled substances. Shalinthia Miles, a patient from Brooklyn, wrote in a Google review that she received an open bottle of medication that was missing 10 pills. In an email to MedPage Today, Miles said she has since filed a complaint with the New York State Office of Professions Pharmacy Unit.

Capsule did not respond to requests for comment about customer complaints or potential drug diversion.

Arash Dabestani, PharmD, senior director of pharmacy at the NYU Langone Medical Center, said there have been discussions in the pharmaceutical community about the regulation of digital pharmacy startups. Dabestani said that there are a few concerns that have emerged with courier delivery models including security of transporting narcotics, as well as the risks of delivering drugs to the wrong patient. However, he added that drug diversion has not been an issue that regulators are concerned about.

In an email to MedPage Today, the Drug Enforcement Administration said it has no policy about how general prescriptions or controlled substances are transported to patients.

Dabestani also raised concerns about how digital pharmacies may interrupt continuity of patient care, specifically for those with chronic diseases.

“A critical component of that disease management is medications, and medication compliance and adherence,” Dabestani said in an interview with MedPage Today. When a doctor loses visibility into a patient’s medication regimen, managing illness is difficult, he said. When a patient needs to take dozens of medications, human interaction with their pharmacist can be a key aspect of patient care.

“For cosmetic medications, oral contraceptives, and non-chronic, non-sensitive patients, it’s probably a good option,” Dabestani said of the digital pharmacy model. But for chronic disease patients, complex medication regimens may require a more hands-on approach: “You certainly want that face-to-face.”

Steve Moore, PharmD, president of the Pharmacists Society of the State of New York, agreed that losing the human interaction with a pharmacist may compromise patient education.

“It’s neat to see how this technology can be utilized,” Moore said in an interview with MedPage Today. “But I don’t think it’s ever going to replace the human element.”