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Can Amazon Fix Adherence? Part 1

Last week Amazon announced the long anticipated debut of Amazon Pharmacy. Although many are clamoring over Amazon’s pharmacy disruption, there’s a key issue missing from the noise: adherence. At the end of the day, a pharmacy is about delivering care to health seekers, usually through medications and treatments; and those treatments only work as well as the patients’ adherence to them. Non-adherence has plagued healthcare, and even with advances in technology, an estimated 50% of people with chronic disease still aren’t taking their meds properly. While many cite cost and convenience as the prime barriers to adherence, there is one obstacle that even Amazon will struggle with: trust.

Non-adherence is a complicated, multifaceted issue but we can break these challenges into three broad categories.

Cost

In the US Healthcare system, medication costs lack transparency. The difficulty of understanding why a medication costs what it does with or without insurance continues to be a barrier to many health seekers. Only in America do people have gofundme campaigns to help cover the costs of insulin or chemo. The costs isn’t just limited to drug pricing, but the cost of facilitating healthy living, many of which are considered social determinants of health, such as lack of safe and healthy housing, groceries and transportation.

Amazon is tackling drugs costs with their Amazon Prime prescription savings, offering prime members discounts through a partnership with Inside Rx for savings of up to 80% off generic and 40% off brand name medications.

Capability

Many treatment plans require tedious regimens and methodologies. Polypharmacy aside, medication management can be difficult for health seekers who struggle with self-efficacy of treatments: such as difficulties opening pill bottles, measuring doses, and remembering to take medications on time. For health seekers, the ability to take their medications as prescribed depends not only on their own capabilities but also the convenience of treatment options.

Amazon’s acquisition of PillPack in 2018 means they will be offering personalized packaging to help ease the taking of medication. Amazon’s Alexa has also piloted prescription refill programs, so users can simply ask Alexa to have the pharmacy fill their RX. Paired with prime delivery and Alexa reminders, medication adherence should be easy enough…right?

But, as many of us know, just because drugs are easily available, doesn’t mean you will take them as you should.

Comprehension

Comprehension is a broader term that encompasses health literacy, patient education, self-management, and contextualized understanding. Basically, how do providers respond to the statement “I don’t want to take my meds” and others like it. Facilitating treatment comprehension that responds to a health seeker’s concerns, allows health seekers to be fully informed and in control of their own health decisions. And while medication information is abundant, medication comprehension is not.

Amazon’s Alexa already provides medication information, and surely the Amazon Pharmacy web content is inspired by Amazon’s best retail content strategies, with plenty of information and data to help communicate the medication’s purpose… but is that enough?

No. It’s not. Even if Amazon is able to minimize drugs costs and maximize the convenience of medications, they will not be able to fix adherence. Amazon will try to squeeze patient comprehension into their pharmacy offering, but it won’t be nearly as effective as other care providers that were designed with health education in mind — such as Omada and Virta. Even with their Halo and Alexa consumer products, and now their new pharmacy service, Amazon is missing the most valuable part of the adherence equation: trust.

Trust

Trust, which can be considered the ultimate form of health comprehension, is the belief that what you are prescribed will help you and is for the best. It’s built on human relationships: the give and take between provider and seeker, the listening, advocating and comprehension of what actions serve the health needs of the seeker. Human relationships are cultivated when promises are kept, concerns are heard and dialogue is continuous. Ask any health seeker today and they will tell you of an experience where their health provider did not listen to them…who’s to say Alexa can do better?

While many are predicting that Amazon will soon launch their telehealth platform for consumers, I’m skeptical that consumers will want Amazon branded care providers so intimately involved in their lives. Perhaps we will see Amazon health providers available through Amazon Prime/Chime/Care, but I know I would personally associate any Amazon employee with the negative press around Bezos’ employee treatment and the lower skill level of most consumer facing Amazon employees, like delivery drivers. My assumptions are guided by sentiment, not necessarily logic and I wager that many other consumers will feel the same way too.

At the end of the day, what’s the point of the pharmacy? To deliver care. And care can be as complicated, nuanced and intricate as each individual health seeker. Even if there is no one size fits all solution for adherence, Amazon will not be able to fix adherence if they continue to ignore the importance of health comprehension and trust, neglecting the human relationships that foster lasting change.

Stay tuned for the part 2 of this series to see how Amazon can leverage their existing ecosystem to scale trust and tackle adherence.

Ari Mostov is passionate about scaling healing through content and technology. She is the founder of WellPlay, a health entertainment company.

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