Net Net: Promoting innovation and managing change
Net Net: Promoting innovation and managing change

Behind pharmacy counter, pill-packing robots are on the rise

Andrew Zaleski, special to
The pharmacy of the future is here and it's run by robots

Doctors at the University of California San Francisco Medical Center look after about 600 patients on a typical day, and each of those patients, on average, take 10 different medications during their stay. More than 200 pharmacists and pharmacy technicians ensure patients receive their prescriptions. But behind the scenes is a group of pharmacy robots sorting through various medications, picking pills in the proper dosages and packaging them for nurses to administer.

"We've been focused on reducing cost and improving quality for patients for years, and technology really gives us an opportunity to do that," said UCSF Health CEO Mark Laret. "What we now have is a pill picker that fills all of the pharmaceutical orders for our patients. … And what's it really done is improved the reliability of what we do."

For years tasks like counting pills and putting them into bottles or individual packages were the purview of pharmacists, especially during the 2000s, with the boom in retail pharmacies.

Last decade the number of chain drugstores like CVS and Walgreens increased by 11 percent, to 39,000, nationwide. More than 2.5 billion prescriptions are filled annually by these stores, which employ close to 120,000 pharmacists, according to the National Association of Chain Drug Stores. In addition to filling prescriptions and checking dosages, pharmacists are oftentimes the people who provide counsel to patients who have questions about the medications they've been prescribed.

"When you have a pharmacist verbally communicating with you, you're more likely to communicate and understand that information," said Mohamed Jalloh, spokesman of the American Pharmacists Association. But the new robotics pharmacy trend is taking hold at hospitals across the United States and even at community chain drugstores.

PillPick system by SwissLog
Source: SwissLog

Hulking machines like the PillPick — a robot manufactured by SwissLog, an international firm with U.S. headquarters in Colorado that's owned by Kuka Robotics — are taking on the task of filling prescriptions. At hospital pharmacies, these robots pick, package and dispense individual pills, often bar-coded to provide extra assurance a patient is receiving the right medication. After orders are verified by pharmacists, they're sent off to patients.

According to BCC Research, the global pharmacy automation market was valued at $3.5 billion in 2015 and will increase to $5.5 billion in 2021.

Proponents of the technology point out that not only are pharmacy robots more efficient than their human counterparts in assembling medications but they are also far less likely to make errors along the way. One study completed at a Houston hospital in 2012 found that for every 100,000 prescriptions, pharmacists made an average of five errors.

Fewer errors, better safety

It was an overdose in 2008 that prompted the UCSF Medical Center to look into automating its pharmacy.

"A nurse made an error of putting the decimal point in the wrong place and we overdosed a patient, and at that point, we made a commitment to that we didn't ever want that to happen again," Laret said.

Since introducing robots to its pharmacy in 2010, the UCSF Medical Center has seen fewer pharmacist errors and better patient safety. During the technology's phase-in period, 350,000 prescriptions were filled with no errors.

"A lot of institutions are chasing zero, hoping to get to the point where they have zero patient errors," said Rita Jew, director of the UCSF hospital pharmacy at Mission Bay. "Once you've programmed the robot to do the right thing, it'll always do the same thing over and over again, without errors, unless humans introduce those errors along the way."

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The UCSF Medical Center makes use of one SwissLog PillPick machine, as well as three robots that prepare IV fluids for patients and four robots that find and pick out medications stored away in a system of boxes as opposed to the shelves where pharmacies traditionally store medications. After robots in the hospital pharmacy package pills, wheeled robots called TUGs help deliver them to hospital patients. UCSF Medical Center employs a fleet of 25 of these robots, which are manufactured by Pittsburgh-based Aethon.

The Nebraska Medical Center purchased a SwissLog PillPick robot for more than $1 million in 2007. It runs 24 hours filling out about 10,000 prescriptions per day. The benefits have included a 70 percent reduction in calls from nurses regarding missing doses, according to one case study.

Prices of PillPick machines vary based on what a hospital pharmacy needs. A hospital that has to dispense 10,000 meds per day, like Nebraska Medical Center, needs a PillPick that can handle more thru-put, which leads to a higher price tag on the robotics investment, because the machines are custom-designed. Swisslog doesn't share a base price and would not discuss pricing for any current clients.

Having the robot also speeds things up. Pharmacy manger Melissa Welch said the robot has dramatically reduced the amount of time pharmacists and pharmacy technicians spend preparing medications. Before installing the robot, it took several pharmacists 12 hours to fill the medication cart for overnight patients. With the robot, it now takes only four hours.

"The robot takes part of the process out of the human hand of picking the medication and potentially picking the wrong thing," Welch said. "Pharmacists verify those orders … but it adds efficiency to your workflow."

Coming down from a pill-popping decade

The move toward automating pharmacies comes at a time when pharmacy schools nationwide have seen greater enrollment. According to Frank Romanelli, associate dean of the College of Pharmacy at the University of Kentucky, the explosion in community pharmacies — drugstores like CVS — in the 2000s led to an increase in demand for pharmacists.

But times are changing. In 2015, Romanelli co-authored an article that predicted an oversupply of about 40,000 pharmacists by 2022. This potential glut in the workforce isn't necessarily due to more automation, but rather a contraction in the number of pharmacies opening up nationwide.

"Community pharmacies aren't opening in the same volume they were 10 years ago," Romanelli said.

CVS shares fell on Tuesday by 16 percent — though they recovered somewhat along with the market after the post-Election Day rally — after the company provided an earnings and outlook that showed a prescription-business slowdown. CVS said in its earnings, "Very recent pharmacy network changes in the marketplace are expected to cause some retail prescriptions to begin migrating out of our pharmacies this quarter. ... In addition, we are currently experiencing slowing prescription growth in the overall market."

In addition, automation in any workplace leads to a conversation about whether robots are stepping in to take jobs away from humans. Before robots were installed in the hospital pharmacy at UCSF Medical Center, it took seven pharmacy technicians supervised by as many as four pharmacists to find medications and dispense the right dosage for each patient. With the robots, the task now requires only two technicians.

But according to pharmacists and industry observers, pharmacy robots aren't replacing jobs. Instead, they're taking over menial tasks, such as counting pills, and freeing up pharmacists to do higher-order jobs.

"Automation is not replacing jobs but enhancing them," said Melissa Elder, a pharmacy automation analyst for BCC Markets. "Many of the automation technologies were designed to replace technicians and this is not the case to date. Support staff in the pharmacy, namely technicians, are continuing to see increasing demand among employers."

The American Pharmacists Association is actually a supporter of automation in pharmacies around the U.S. Jollah said it's unlikely robots could ever replace pharmacists, who still have an important role to play in not only counseling patients, but also checking for drug-to-drug interactions between prescriptions.

"The level of judgment and expertise that pharmacists provide can't be replaced by robots," he said.

Today at UCSF Medical Center, pharmacists are able to interact with patients and doctors more, and that's a direct result of the robots now working in the hospital pharmacy.

"There's always going to be humans," Jew said. "But now our pharmacists are an integral part of the medical team, going on rounds with physicians and nurses. We wouldn't be able to do that if pharmacists were just tied down checking products."

Net/Net takeaways

The global pharmacy automation market will increase by $2 billion in value over the next five years, to $5.5 billion.

Robots speed up workflow, but the No. 1 reason for increased use of pharmacy robots is reducing cases of patient error to zero.

The automation trend doesn't stop at sorting pills; it is extending to more tasks in the hospital, including mixing IV fluids.

The pharmacy business boomed in the 2000s, but there are signs of a slowdown and less pharmacist jobs, even without direct pressure from robots.

By Andrew Zaleski, special to

(Correction: Mark Laret is CEO of the University of California San Francisco Medical Center. An earlier version of this article misstated his title.)