Jerry Fahrni

The InstyMeds Prescription Medication Dispenser is a fully automated prescription dispensing machine. It is  designed to be used in high traffic areas where quick medication turnaround is desired and a physical pharmacy is unavailable, such as emergency departments (ED) and acute care clinics.

The dispenser has just over 100 medication slots that can each hold a medication magazine with up to 11 prepackaged medication bottles. The formulary for the InstyMeds machine is site specific and designed by the InstyMeds Corporation. Items in the example formulary that I viewed included amoxicillin capsules, amoxicillin suspension, Auralgan otic drops, Z-Pak, Augmentin, acetaminophen tablets and elixir, ibuprofen, Vicodin, Darvocet, etc. All the items you would expect from a short visit to the ED or for little Joey with an ear infection at the urgent care. The formulary in the InstyMeds machine can be altered based on seasonal trends and inventory replacement is automatically  shipped to the location when needed based on real time inventory tracking. In addition, consumables such as printer paper are also automatically tracked by the InstyMeds Corporation via an internal web cam.

Prescriptions for the InstyMeds machine are generated by physicians via web based prescription writing software that is integrated with the facilities ADT system. The electronic prescription is sent to the insurance company where it is adjudicated and the patient is given a paper script called a voucher. The voucher contains an “InstyMed code” that can be used by the patient to retrieve their medication at the InstyMeds dispenser. Medication co-pays can be made via credit card or cash at the machine.

Medications in the InstyMeds Medication Dispenser go through a triple barcode check process prior to being dispensed to the patient. Check number one is performed by scanning the barcode on the medication magazine, the second check is performed by scanning the barcode on the medication bottle, and the final check is performed by scanning the barcode on the patient prescription label and comparing it against the barcode on the bottle. The medication is dropped into a reject bin at the bottom of the machine if any of the three barcode checks fail.

Questions regarding insurance coverage, billing, or medication information can be obtained by simply picking up a direct-dial phone attached to the InstyMeds machine. This service is available 24/7 and is provided by the InstyMeds Corporation as part of the contract. If, after receiving their voucher, the patient would rather have a hard copy prescription to take elsewhere, they simply pick up the direct-dial phone and the person on the other end will reverse the insurance adjudication and print a prescription for the patient. Nothing could be simpler.

We are in the process of evaluating these devices for some or our outpatient clinic areas where a “pharmacy presence” has been requested. The ideal solution would be to provide small outpatient pharmacies at these locations, but that has become problematic in the current economic climate. There is no charge to lease the InstyMeds Medication Dispenser; rather the company collects a dispensing fee for each prescription generated.

Overall the InstyMeds machine is a slick piece of technology and could be of great benefit in certain circumstances. California currently allows this technology to be used in the outpatient clinic setting, but the California State Board of Pharmacy has yet to rule on its use in a hospital setting. When I asked the InstyMeds representative about safety I was told that they have dispensed approximately one million medications without a single error to date. Those are pretty good numbers, but I have no hard data to back up the claim. One thing I don’t like about the system is the removal of a pharmacist from the medication process. Most patients will never make use of the direct-dial phone and therefore never receive consultation regarding their medication. Placing a pharmacist in the clinic to consult the patient about their medication prior to receiving an InstyMeds voucher would be the perfect solution. That’s still more economical than opening a physical outpatient pharmacy at the site.