Lawmakers advance automated pharmacy bill

The kiosks would connect patients with a telepharmacist and dispense pills from a machine.

Coloradans may soon be able to fill prescriptions via a video screen and a pre-loaded dispensing machine, thanks to a bipartisan bill that sailed through the House earlier this month.

Just don’t call them vending machines.

“We call them automated kiosks, rather than vending machines,” said Amy Gutierrez, the chief pharmacy officer for UCHealth. She was the president of California’s pharmacy board when that state signed off on the kiosks several years ago. “From a professional standpoint, they’re connected to a pharmacist.”

Pitched as a way to improve access to medications at odd hours and in underserved areas, HB231195 would allow these kiosks to open across Colorado. The machines, which look like refrigerators with a large screen and opening, would be pre-loaded with prescriptions, already counted and filled. A live human pharmacist, connected via video link, would consult with the patient and clear the way for the medicine to be dispensed. Current regulations around prescriptions — like double-counting of pills and ID checks for controlled substances — would still be in effect, said bill sponsor Rep. Dafna Michaelson Jenet, a Commerce City Democrat.

It’s a forward-looking bill, she said, that both keeps Colorado in line with technological shifts while better serving patients. It can help rural communities that don’t have pharmacies, supporters say, or urban residents with busier schedules. A hospital could, for instance, open a kiosk in its emergency department, for patients who’re seen at late hours.

“If you work a regular schedule and then you have to come home and maybe feed the children, at the end of the day, you’ve missed the pharmacy hours,” Michaelson Jenet said. The bill passed the House with 58 aye votes and just four noes. It has Republican cosponsors and is set for its first Senate hearing in late March.

The kiosks would not all be uniform in the medications they offered. If, say, a hospital opened one near its emergency room, that kiosk could be filled with more emergent prescriptions, like nar

cotics or antibiotics. If there’s an area with a specific need for blood pressure medications, any kiosk there could be stocked up to that end.

It’s not a completely autonomous or perfect system. A living provider still needs to stock the machines, and they wouldn’t have every dosage or amount of pills. After the Colorado Pharmacists Society raised some concerns about the kiosks siphoning work from providers who live here in favor of telepharmacists who live anywhere, the bill was amended to say that machines can only be in use when the attached physical pharmacy is closed. A tele-provider would still monitor the machines, which would have to be in “secure” locations, 24 hours a day.

Still, even if a kiosk doesn’t have the medicine you need at that moment, patients can still benefit from talking with a pharmacist, Gutierrez said. Colorado would be far from the first state to allow the kiosks: Illinois, Texas, Nevada, Florida and California, among others, have all approved them.

There won’t be extra costs for patients who use the machines versus a physical pharmacy, lawmakers and supporters say. A representative for MedAvail Technologies, which makes the kiosks, declined to say how much the machines cost.

Emily Zadvorny, the executive director of the pharmacists society, said the group understood that this is where technology is headed. While workforce issues have plagued health care broadly since COVID-19, Zadvorny said that there are plenty of pharmacists. But the culture and workload from large chains are the issue. Some, she said, are offering $75,000 signing bonuses to entice new hires and still aren’t getting any takers.

She’s generally supportive of the bill, with questions about some of the details, though smaller, independent pharmacies still had concerns. The industry needs to be ready to move forward, she said.

“As a profession, we’ve gotta be OK with saying, ‘The actual dispensing function of prescriptions is probably going toward technology and support personnel,’” Zadvorny said. “And our role as pharmacists need to be on the other side helping patients adhere to their medicines, helping them understand and take them correctly and get good outcomes from their medicines.”