As ultra-fast prescription delivery services reshape medication access, healthcare providers face an urgent challenge: balancing patient convenience with medication safety. With 1 in 5 adults using five or more prescription drugs and medication-related problems consuming 1 in 6 healthcare dollars ($528B annually), the stakes are high.
In this interview, Yoona Kim, CEO of healthcare AI company Arine discusses how the evolution of prescription delivery services, while improving access, may inadvertently contribute to dangerous polypharmacy and medication mismanagement. She comments on the critical challenges facing healthcare providers, from fragmented medication tracking to rapidly evolving drug knowledge, and explores how AI-powered solutions can help ensure safe, effective medication management in an increasingly automated healthcare landscape.
What are the potential benefits and risks of ultra-fast prescription delivery services like Amazon Pharmacy’s same-day delivery? How can these services impact patient access to medications and adherence to treatment plans?
Yoona Kim, Founder & CEO at Arine: Ultra-fast prescription delivery services like Amazon Pharmacy’s same-day delivery offer clear benefits to patients, particularly those with acute health needs. Instead of having to pick up medication from the pharmacy – while potentially feeling under the weather – patients can have medications delivered straight to their door within hours. It’s easy to see why this level of convenience is appealing, especially as we grow accustomed to rapid delivery in other areas of our lives, such as grocery shopping.
However, this convenience comes with considerable risks in our already fragmented healthcare ecosystem. To start, it complicates providers’ ability to track a patient’s medications. People often, and erroneously, assume that healthcare providers have a clear, comprehensive picture of a patient’s prescriptions, but that’s not usually the case. For example, when someone is admitted to the hospital, their doctors need to piece together their medication history, often by conducting a medication review with the patient, calling their PCP, consulting specialists, and sometimes reaching out to family members. Even with those efforts, up to two-thirds of hospital patients have something missing or incorrect in their medication records, which can lead to risky drug interactions.
In addition, patients are often confused by their medications. For these individuals, having an additional interaction with a pharmacist can be invaluable. As medication therapies become more complex, the role of pharmacists has expanded beyond simply dispensing, to educating patients around safe medication use, and warning them about drug interactions. When this touchpoint is removed, patients may lose an opportunity for crucial medication counseling.
So while Amazon’s prescription delivery might be a game-changer when it comes to convenience and speed, we do need to ensure that it isn’t hindering providers’ ability to quickly access accurate medication information, and not preventing patients’ access to comprehensive medication counseling.
Could these services’ convenience and speed inadvertently contribute to overprescribing and polypharmacy? If so, how?
Yoona Kim: While the convenience and speed of same-day delivery are a huge win for patients, it’s important to remember that medication isn’t the same as groceries or other deliveries – even the most common and seemingly harmless drugs need careful consideration from healthcare professionals. When big retailers start handling medications like they do other consumer products, it can unintentionally reduce the medication oversight patients really need. It is already difficult enough for providers to weigh the risks and benefits of medications with existing data silos. At the same time, pharmacists do not have sufficient visibility into medications dispensed at other pharmacies to catch potential interactions.
The shift toward a fast, Amazon Prime-style delivery model could make this situation even more difficult, since it’s adding yet another dispensing pharmacy into the mix. We really need safeguards to make sure patients aren’t getting medications they don’t need – or worse, medications that could harm them.
One of the big risks here is inappropriate polypharmacy, which happens when patients end up taking five or more medications at once. Today, about 1 in 5 adults take five or more medications; with the rate twice as much for older adults. This is a serious issue that can lead to dangerous drug interactions which put patients at risk of hospitalization and even death. When patients can conveniently refill their prescriptions and have them delivered in just a few clicks, medications can arrive without a clinician reassessing whether they’re still right for the patient. As a result, a patient could receive a drug they no longer need or even a duplicate prescription.
It’s not the convenience that’s the problem, but we do need safeguards. If we don’t address this, we could see over 4.6 million additional hospitalizations and as many as 150,000 premature deaths in the US over the next decade alone.
What are the potential consequences of overprescribing and polypharmacy for patients, including adverse drug interactions, increased hospitalizations, and higher healthcare costs?
Yoona Kim: The risks of overprescribing and polypharmacy are well-documented and, unfortunately, very real for patients – the more drugs you’re on, the higher the chances of costly and harmful drug interactions and other consequences. Take elderly patients with heart disease – when they’re on five or more medications, their healthcare costs nearly double while their pharmacy expenses triple compared to those taking fewer drugs.
Patients taking five or more medications face nearly twice the risk of adverse drug events, leading to outpatient clinic or emergency room visits. This trend is especially concerning in certain disease areas such as behavioral health where we’re seeing an alarming increase in polypharmacy. Currently 60% of adults with behavioral health conditions are prescribed two or more psychotropic medications, a practice that frequently leads to more emergency room visits and higher healthcare costs.
Hyperpolypharmacy – when a patient is on 10 or more medications – can be even more consequential. A study found that hyperpolypharmacy remained significantly associated with an increased risk for hospitalization for any reason and any serious adverse event.
Despite these risks, polypharmacy has been rising quickly. In the past two decades, the number of older adults in the US taking five or more medications has almost doubled to over 44%.
Addressing polypharmacy can be tricky and there is no known structured approach given that these are patient-specific interventions with many factors to consider such as patient goals, medications used, and preferences. There are treatment guidelines for initiating treatment for almost every disease area, but not as clear in these guidelines is when to discontinue medications.
Regular reviews of each patient’s medications are essential so clinicians can spot duplicates and identify any drugs that may be causing more harm than good. This way, when necessary and possible, they can work with patients on a safe plan to deprescribe – in other words, taper off these medications. But achieving that level of oversight becomes harder as the focus on convenience and rapid refills continues to grow.
How does the rapid evolution of medication knowledge and drug interactions challenge healthcare providers to ensure safe and effective medication management?
Yoona Kim: Medication knowledge is evolving faster than ever, which can actually be a double-edged sword for healthcare providers. Every year, dozens of new drugs get FDA approval, while existing medications gain new uses – or new warnings about potential risks. Doctors are trained on medications during medical school, but keeping up with all the updates year after year is almost impossible.
This constant influx of new drugs and changing guidelines means that even the best-resourced healthcare providers can struggle to stay fully informed.
There are platforms that providers can use to look up drug interactions and active ingredients, but these resources don’t account for all the individual factors that might impact how someone responds to a medication.
For truly safe and effective medication management, providers need a full, up-to-date view of not only the drugs themselves but also the patient’s unique clinical, social and behavioral circumstances. Keeping track of all this information in real time is a major challenge for healthcare providers, especially as medication knowledge continues to expand.
What are the potential consequences of medication mismanagement across the healthcare continuum, from primary care to hospitals and long-term care facilities?
Yoona Kim: The consequences of medication mismanagement are severe across the continuum. In fact, medication-related problems are the largest area of waste in our healthcare system and 1 in every 6 healthcare dollars or $528B annually are spent on consequences from suboptimal medications. To illustrate this issue, let me share the story of two patients we’ve encountered at Arine.
Patient E, a man with heart failure, diabetes, COPD, and previous hospitalizations was prescribed multiple doses of the same heart medications by different providers over two months. Every time he was hospitalized again or received a new prescription, he didn’t understand that he was supposed to stop taking the previous medication he’d been prescribed. No one noticed that he was taking multiple duplicates of 6 heart failure medications at the same time, which could have led to renal failure and cardiac arrest. Without intervention, the outcome could have been fatal.
Patient P who was battling multiple heart conditions – including heart failure, atrial fibrillation, and a previous heart attack, alongside COPD and blood clotting issues – had experienced multiple hospitalizations within a year. Despite the severity of his conditions, he struggled with taking his prescribed heart and blood-thinning medications consistently and had gone nearly a year without seeing a cardiologist. He was also missing key medications necessary to better manage his condition. Without proper medication adherence, additional necessary treatments, and specialist oversight, his health was at significant risk for further decline and complications.
These are just two examples, but millions of Americans face similar challenges every day. There’s a common misconception that doctors and pharmacists have full control over patients’ meds. But in reality, keeping track of everything from a patient’s full medical history to their socioeconomic challenges – like paying for meds, transportation issues or even health literacy barriers – is incredibly hard. Providers would need a complete 360-degree view of each patient’s life to get every prescription right, which is just not realistic with the current system.
How can technology and AI be leveraged to enhance medication management and reduce the risks of overprescribing and polypharmacy?
Yoona Kim: Using technology and AI is the only way to tackle an issue as enormous as medication management. The complexity of today’s healthcare system and the sheer volume of medication knowledge make it impossible for providers to keep track of every new guideline or patient-specific factor without the support of technology. AI can sift through massive data sets in order to connect the dots between the latest medication information and each patient’s unique health and life circumstances to recommend a safe, optimized medication plan.
Can you explain how Arine’s medication intelligence platform addresses the challenges of overprescribing and other forms of medication mismanagement?
Yoona Kim: Our AI-powered medication intelligence platform assesses everything from optimal drug choice, drug dose, or duplication errors and harmful interactions, to socioeconomic factors that could be acting as a blocker in an otherwise sound treatment plan. These are presented to the provider as specific data-driven recommendations, including contextual information about the patient’s circumstances, and helps them make more informed decisions. In areas like overprescribing, this is essential. Our platform flags unnecessary medications that may be causing more harm than benefit and suggests deprescribing or changing medications as needed, again in the context of the full patient picture.
While much of the conversation around AI in healthcare has been purely speculative, Arine’s technology offers a tangible solution to a specific problem with proven positive impacts on patient outcomes. Through medication intelligence, we were able to identify and correct the medication errors that were affecting Patient E and Patient P’s treatment plans.
Patient E’s duplicative heart failure medications were deprescribed and his heart failure is much better controlled on fewer medications and lower costs. Patient P was counseled on the importance of adherence and put on a more comprehensive treatment regimen with additional heart failure medications to prevent more hospitalizations, supported by his new cardiologist.
What are the key challenges and opportunities that lie ahead in addressing medication mismanagement, particularly as the paradigm of drug dispensing continues to evolve?
Yoona Kim: As more retailers like Amazon move into pharmacy, there’s a big shift toward automation, and with it, both challenges and opportunities. One of the biggest concerns is the potential for automated prescription refills to create a disconnect between healthcare providers and patients. Providers need visibility to all dispensed medications and the full patient picture to properly review and prevent unnecessary negative consequences of medication errors. Patients need proper counseling as taking medications incorrectly could end up undoing the convenience that automated services are trying to provide.
On the flip side, automation could actually be a major win for healthcare, especially in reducing the heavy administrative workload on doctors and pharmacists. Streamlining some of these repetitive tasks could free up their time for direct patient care, and help to prevent burnout and keep more providers in the profession. But it’s all about balance – if we’re building guardrails to ensure that the convenience at the prescription level flows all the way through to safe, efficient care, particularly leveraging AI and technology, we stand to improve patient outcomes and reduce costs.
About Yoona Kim
Yoona Kim is the CEO and co-founder of Arine, a next-generation medication intelligence company with a mission to solve medication mismanagement across the healthcare continuum. Arine’s proprietary platform pulls insights from a complex ecosystem of clinical, socioeconomic, and behavioral data to generate personalized care plans and deliver value-based care. Yoona previously led clinical and health economic activities at leading digital health and pharma companies including Novartis and Gilead. She also implemented innovative healthcare design and value-based insurance programs for large self-insured employers at Mercer Health and Benefits. She holds a bachelor’s degree from Stanford University, a PharmD with an emphasis in health policy and management from the University of California, San Francisco, and a PhD in health economics and outcomes from the University of Texas at Austin.