By admin 
The landscape of American healthcare is undergoing a radical transformation as the "retailization" of medicine moves from the digital screen to the physical kiosk. This next phase of direct-to-consumer healthcare involves several major corporations, including Amazon and specialized pharmacy tech firms, beginning to fill prescriptions for common medications at electronic kiosks located in high-traffic areas and clinical settings. Amazon Pharmacy recently announced the launch of electronic kiosks at One Medical locations, a move designed to bridge the gap between a physician’s diagnosis and the patient’s receipt of treatment. These kiosks, which function essentially as high-tech vending machines for pharmaceuticals, carry drugs used by millions of patients across the United States, promising a future where the friction of the traditional pharmacy counter is replaced by the efficiency of a digital interface.
The scale of the American pharmaceutical market is staggering, with more than 20,000 prescription medication products currently approved for marketing by the Food and Drug Administration (FDA). As the variety of treatments grows, so does the volume of consumption. Current data indicates that 20 percent of adults in the U.S. take five or more prescription drugs simultaneously, a phenomenon known as polypharmacy. Furthermore, half of the adult population reports taking at least two prescription medications regularly, a figure that does not even account for the massive consumption of over-the-counter (OTC) medicines and dietary supplements. This culture of "medication overload" creates a complex web of chemical interactions that clinicians must manage, often with incomplete information.
The primary challenge for modern clinicians is the fragmentation of patient data. Patients frequently have their complete medication profiles dispersed across multiple prescribers, various independent and chain pharmacies, and diverse retail channels. Consequently, a patient’s full therapeutic regimen—including prescription drugs, OTC products, and supplements—is rarely visible at the point of care. These information gaps make it increasingly difficult for healthcare providers to anticipate clinically significant drug-drug interactions or the duplication of therapy, where a patient may inadvertently take two different brands of the same drug class.
In this evolving context, kiosk dispensing models that operate outside traditional pharmacist workflows may inadvertently exacerbate these risks. By removing the pharmacist from the physical point of pickup, these systems may reduce critical opportunities to identify medication conflicts or provide essential counseling. For individuals with complex or uncoordinated regimens, particularly the elderly, the absence of a professional review can increase the likelihood of therapeutic duplication and suboptimal medication use. These factors are directly associated with avoidable adverse drug events (ADEs), which remain a persistent shadow over the American healthcare system.
The operational model of a pharmacy kiosk is deceptively simple. A patient receives a prescription from a physician during a visit to a clinic, urgent care center, or via a telehealth session. Rather than traveling to a traditional brick-and-mortar pharmacy, the patient simply approaches a secure electronic kiosk, enters their information, and retrieves their medication. The entire process can be completed in a matter of minutes and often occurs without any direct interaction with a licensed pharmacist. On the surface, this efficiency is highly appealing. It addresses the "last mile" problem of healthcare and offers a solution to the growing crisis in community pharmacies, which are currently plagued by severe staffing shortages, burnout, and increasing workload pressures that have led to nationwide walkouts.
However, healthcare advocates warn that even a brief thirty-second exchange at a pharmacy counter serves as a vital final checkpoint in the care delivery system. This interaction provides an opportunity to review new therapies, clarify complex dosing schedules, identify potential interactions with a patient’s existing medications, and answer questions that the patient may have been too overwhelmed to ask during their clinical visit. Removing this human element without a digital equivalent could have dire consequences.
The stakes are high. According to the Centers for Disease Control and Prevention (CDC), unintentional injuries, which include adverse drug events, rank as the third leading cause of death in the United States. These ADEs are responsible for an estimated 1.5 million emergency department visits annually, with nearly 500,000 of those cases requiring hospitalization. The financial burden is equally staggering. When combined with the broader issue of medication mismanagement, the U.S. spends more money addressing medication-related problems—an estimated $528 billion as of 2016—than it spends on the medications themselves, which totaled approximately $329 billion in the same year. This "waste" in the healthcare system represents a failure of coordination that costs both lives and resources.
The demographic most affected by these failures is the aging population. The majority of Americans who take more than one prescribed medication daily are seniors and individuals living with multiple chronic illnesses. Fatal adverse drug events are significantly more common in people aged 55 or older, and the severity of these events increases exponentially for those over the age of 75. For this population, the pharmacy kiosk must be more than a vending machine; it must be a clinical tool.
In an effort to mitigate these risks, the Center for Medicare and Medicaid Innovation (CMMI) launched the Enhanced Medication Therapy Management (EMTM) project in 2017. This experimental model provided financial incentives for private prescription drug plans to develop innovative solutions to prevent ADEs. The core of the program involved fostering closer collaboration between pharmacists and physicians to improve the assessment of a patient’s total medication profile. The results, published in a 2021 study in the American Journal of Managed Care, were profound. Medicare Part D beneficiaries who received comprehensive pharmacist-delivered medication safety reviews showed notable improvements in total medical costs, reduced hospital stays, fewer emergency visits, and lower death rates compared to those who did not receive such services.
While the EMTM model concluded in December 2021, its legacy provides a roadmap for the integration of technology in pharmacy. It proved that addressing medication interactions before they escalate into adverse events can save lives and reduce net Medicare expenses. The lesson for companies like Amazon is clear: medication safety improves when patients receive timely, accessible support that helps them navigate complex choices.
Fortunately, emerging digital tools can play a complementary role in this process. When pharmacy kiosks are purposefully designed with decision-support capabilities, they have the potential to enhance safety rather than diminish it. A recent study involving older adults demonstrated that an interactive kiosk providing tailored, condition-specific information significantly improved the appropriateness of over-the-counter medication choices. For example, participants using the kiosk were far less likely to select products with a high anticholinergic burden—a known risk factor for cognitive impairment and falls in the elderly. The study found that users rated the digital interface as both usable and acceptable, suggesting that technology can guide safer decision-making if it is integrated thoughtfully.
Furthermore, research into contactless prescription kiosks within large health systems has shown that these machines can perform as well as, or better than, traditional counter service in certain metrics. These include lower rates of "prescription abandonment"—where a patient never picks up their medication—and high reports from pharmacists regarding their ability to address patient questions through integrated communication channels. This indicates that kiosk-based dispensing, when paired with professional oversight and clear triage pathways, can preserve safety while expanding convenience.
As these systems evolve, the role of artificial intelligence (AI) will become central. AI tools can enhance the screening process for contraindications and drug interactions at the point of dispensing. However, these tools must operate under the umbrella of pharmacist-led oversight to ensure accuracy and to protect against "algorithmic drift" or errors. The kiosk should not be seen as a replacement for the pharmacist, but as a sophisticated extension of the pharmacy’s reach.
Policymakers now face the task of aligning this rapid innovation with public safety. To ensure that the "vending machine" model does not compromise patient care, there is a growing call for baseline standards. We propose that policymakers consider several minimum pharmacist engagement standards for new kiosk technologies. First, kiosks should provide a direct, real-time link to a pharmacist via video or audio for any patient receiving a new medication. Second, these systems must be fully interoperable with electronic health records (EHRs) to ensure the kiosk "knows" the patient’s full medical history. Third, there must be mandatory "flagging" systems that prevent the dispensing of high-risk medications without a live pharmacist review.
These guardrails would not limit market competition; rather, they would ensure that any company entering the pharmacy space—whether a tech giant like Amazon or a local health system—meets the same rigorous expectations for patient safety. In a rapidly evolving healthcare marketplace, thoughtful regulation can support technological innovation while preserving the essential safeguards that protect people navigating increasingly complex medication regimens. Rather than slowing innovation, well-designed policy can help modernize medication access while maintaining the clinical oversight required to prevent avoidable adverse drug events. Ensuring that kiosk dispensing models evolve with, rather than apart from, pharmacist-led safety practices is essential to modernizing healthcare without sacrificing the protection of the public.