$1M robot helps the medicine go down

Sep 21, 2015

The robot reads a barcode and extends its long yellow arm toward bins holding 300 different pills. Tiny fingers pick pills from some of the containers, using lasers to detect the size, shape and color of each. The robot ignores decoy pills and drops the pills it has selected into 28 small plastic "blisters" embedded in a page of cardboard. There are four blisters for each day of the week.

It's not exactly Optimus Prime.

But in the near future, this robot, under development at a factory on Gandy Boulevard, could benefit people like 65-year-old Meg McCleary of St. Petersburg. She is one of 32 million Americans who take more than five pills a day.

McCleary takes 13.

Keeping track — of which pills to take, when to take them, remembering if in fact a certain pill has been taken — was a challenge. Three times a day, she had to maneuver through the kaleidoscope of plastic bottles in her bureau drawer. Seven pills in the morning; one at noon; five in the evening.

"I did try putting them all in a pill organizer,'' McCleary said, "but that got to be overwhelming, too."

Relief came from pharmacist Michelle Delp at the Prescription Shop in downtown St. Petersburg. Delp divides McCleary's medication into morning, noon and night doses for each day of the week and places them all in separate compartments in one medicine packet. McCleary calls it a "godsend.''

But it takes Delp about 15 minutes to put together just one week's worth of McCleary's medication — and that's basically why a St. Petersburg company is developing its pill packaging robot.

Robots like MTS Medication Technologies' $1 million M5000 could make the process of filling multidose blister packs much more efficient if adopted by if retail and institutional pharmacies. For instance: where an individual pharmacist might need an hour to fill maybe four packs, the M5000 could do 50.

Money is at stake, and so are lives. Failure to adhere to a medicine regimen:

• Accounts for 125,000 deaths a year, according to the American College of Preventive Medicine.

• Is to blame for $105 billion in avoidable health care costs annually, according to Express Scripts, a giant mail order pharmacy.

MTS has made cards that hold a long-term supply of just one type of medicine since 1984. About 12 years ago, it came out with the multidose cards that can hold multiple pills in clear blister packs marked for various times of the day.

MTS sends empty cards to pharmacies around the world where they are filled by pharmacists and technicians. The so-called "adherence" packaging is used mostly at nursing homes.

It also helps people living on their own — but who have trouble keeping up with their medication — stay out of nursing homes.

"If you take your medications right, you decrease your total health care costs dramatically," said Troy Hilsenroth, a vice president for California-based Omnicell, which bought MTS three years ago for $156 million.

Multidose blister packs are more common in Europe, where medicine cards with just one kind of pill largely replaced vials and bottles more than a decade ago, Hilsenroth said.

Two million of the estimated 30 million Europeans taking five or more pills a day use multidose packs. About one million of the 32 million Americans taking that many pills a day use them.

"But the new (U.S.) mindset in health care is patient outcome, not just saving money on the front end," Hilsenroth explained.

"There's going to be a tipping point when this becomes the accepted method," said Joe Costa, an Omnicell marketing director, "when insurance companies realize it makes sense to pay more at the front end and less in the actual cost of sickness or hospitalization. And when consumers demand it."

Kevin Sneed, head of USF's College of Pharmacy in Tampa, believes increased use of multidose blister packs will lead to better health.

"One of the biggest challenges we have in this country is getting (patients) to remain adherent to their prescriptions after three to six months," he said. "When they have the blister pack … you don't have to worry about fitting all the pills into one pill box. You don't have to worry about refilling one bottle and then having to refill another bottle later."

While the benefits of multidose packs are obvious, so too are the problems.

It takes Delp at the Prescription Shop 15 minutes to manually package just one week's worth of McCleary's medication.

Delp doesn't charge for the labor intensive service, though some other pharmacists may charge around $20 a month for the extra service, she said.

Many private insurers and Medicare Part D, which covers prescriptions, will reimburse pharmacists for extra time spent helping certain patients. That could be in the form of one-on-one consultations or painstakingly filling a multidose blister pack, according to Todd Wormington, a pharmacist and product manager at MTS.

But their time is only reimbursed for customers who are deemed eligible, perhaps because they just got out of the hospital or have diabetes. The estimated $100 a year per customer might not really cover all the time spent helping them.

Enter the M5000.

While there are automated systems for pouring pills of the same kind into bottles, Sneed said he is not aware of another robot that can custom fill multidose packs with the speed or accuracy of the MTS robot.

Consumers, especially the older ones who are more likely to take multiple medications a day, may be leery of a machine organizing their pills with limited human involvement.

But MTS engineer Eddy Kames, one of the robot's inventors, stands by his creation.

"The biggest advantage from this machine is it's extremely accurate, more so than a human," he said.

Its error rate?

"Zero percent," Hilsenroth said.

Each state has different guidelines on the extent to which a pharmacist must monitor automated pill filling systems. Human eyes will be required to check 2 percent to 5 percent of blister packs filled by the M5000 for quality control, Hilsenroth said.

MTS envisions retail and institutional pharmacies using the robots in a hub and spoke system. They don't need a $1 million robot at every location because it will be so efficient.

Like most other automation, the new technology will replace work humans were doing.

"The objective isn't to reduce head count. It's to improve the product," Costa said. "There will be a redistribution of labor."

Pharmacists will have more time to talk to customers face to face, which benefits their overall health, Hilsenroth said.

"It's truly not the job of a pharmacist to put a pill in a bottle," Sneed said. "We should really be involved in communicating with the prescribers. We should be assessing the patients to make sure those medications are being taken appropriately."

Sneed, who toured MTS several years ago but hasn't seen the M5000 yet, said he feels comfortable with the accuracy of the robot with a pharmacist spot checking cards for quality control.

His concern, however, is consumers who change medications or dosages.

"If there are blister packs being filled for 30 or 90 days out when the regimen may change at day 15, it's not the most cost-effective use of medication," he said.

MTS cranks out a million empty blister packs a day. More than a decade ago, the company's team of engineers and technology experts started creating automated systems to fill those. Predecessors to the M5000, however, weren't nearly as fast or accurate.

Still, the company has grown from 180 to 350 employees since 2005. MTS isn't saying how many two-armed yellow robots it thinks it will sell once the M5000 hits the market in early 2016. Employment is expected to steadily increase at the 130,000-square-foot facility at Gandy Boulevard and Interstate 275.

"We want to grow the footprint in St. Petersburg," Hilsenroth said. "It's a great city, there's a talented pool of workers and it's a reasonable cost of living compared to the San Francisco Bay area" where Omnicell is based.

While institutional pharmacies that fill hundreds of thousands of prescriptions at one site are likely to be most interested in the new robot, retailers may sign on, as well.

"Walgreens and CVS are kind of stepping back and watching us. They see (the industry) changing," Kames said. "It only takes one of them, then the others will have to do it, too."

Source: Tampa Bay Times