Will the HIV Community Shimmy with Amazon Pharmacy, or Dance Elsewhere?

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The Amazon juggernaut saga continues; this time it is with Rx prescription medicines. "Introducing Amazon Pharmacy,"[1] read a recent promotional email sent by the $1.7 trillion dollar company to all of its 72.8 million Amazon Prime members. Amazon has increasingly dominated e-commerce in the United States, but it has yet to make significant inroads into pharmacy sales.[2] That could change, so it begs the question: how will Amazon pharmacy be received by the HIV community?

The answer seems clear...it might be too soon to tell. 

In the United States, Amazon held 49.1% of the e-commerce marketshare last year. The next closet competitors were eBay at 6.6%, Apple at 3.9%, and Walmart 3.7%, respectively.[3] Yet, despite launching its Amazon pharmacy one year ago it appears online consumers are reluctant to jump on the company's bandwagon when it comes time to filling their Rx prescriptions. Orders for medications don't even make it into the top ten most frequently bought products on Amazon.[4]

For the HIV community, several reasons account for consumers sticking with their current pharmacy, according to advocates and industry insiders. The Community Access National Network's (CANN) recent blog, Beyond Medication: Tech Advances in Care Delivery, tackled some of these concerns. Among them, issues over privacy and the company's reputation to "exploit its collection of user data for the sake of profit."[5]

When asked to further comment on CANN's analysis and Amazon pharmacy's impact, Jen Laws added: "It is too soon to know, because the details of them keeping supply chain secure are obscured and their payment processes are exploitive of perceptions on affordability. I think there's a role for them, but I don't know that it's in the model they're building - they did the home test delivery program for the Centers for Disease Control and Prevention with functional successes on speedy delivery, but meds are more sensitive to temp control needs, for example."

Another potential obstacle includes access to copay assistance programs. In a recent opinion piece, Copay assistance should count as part of patients’ cost sharing for medications, Kollet Koulianos and Keri Norris argued, "By not counting copay assistance toward patient out-of-pocket costs, insurers and PBMs are able to collect the same amount of money a patient would contribute to their deductible multiple times."[6] Amazon currently doesn't accept coupons, according to their website.

Photo Source: Amazon

ADAP Educational Initiative's Founder Eddie Hamilton expressed strong concerns over the potential exclusion of copay assistance programs, citing CVS Pharmacy. "CVS started as a retail pharmacy, and now look at them," Hamilton noted in response to Amazon shifting employees to its new cloud-based pharmacy benefit manager, RxAdvance, and Amazon's own PillPack online pharmacy.[7]

"The only real benefactors of the copay accumulator model are the payers and PBMs which in one case are one and the same," argued Hamilton. "As a result, the patients, who are the customers of the payers, suffer financially to the point of financial ruin in as quick as one month." 

For that reason alone, Hamilton believes people living with HIV should think twice before using Amazon pharmacy. He anticipates Amazon's next step would be moving more and more into the PBM space to further funnel pharmacy sales.

He further contends, "Many PBMs will not accept a copay card at the counter nor through mail order. For some patients, depending on the drug, one copay could be 300% of their entire monthly income. So this issue goes beyond the cat food or med scenario."

Concerns over privacy and cost-sharing aside, there are also more intimate issues for patients. Among them, healthcare team relationships. 

According to Glen Pietrandoni, Vice President for Patient and Community Advocacy with Avita Pharmacy, patients living with HIV having a relationship with an HIV-trained pharmacist in the community as part of their healthcare team is an invaluable resource.  

"As people are now living close to normal lifespans with well managed HIV, comorbidities that come with aging may need more careful attention because of drug interactions, polypharmacy and multiple medical providers," said Pietrandoni. "A strong pharmacist relationship, as one would have with their medical provider and case manager can help maneuver through drug interactions, insurance formularies, and adherence. Trust and patient safety are the foundation of the pharmacy profession that can best be provided when the patient, providers, and pharmacist are working together to support HIV focused patient care."  

In Pietrandoni's experience, delivery is a common service offered by almost every pharmacy, it is the pharmacist that patients and their providers know and trust that completes the circle of care. "Simply having medications show up on your doorstep, without the care of a pharmacist you know, is not providing the value you deserve as a patient," he argued.

Currently, Amazon's growing product catalog doesn't reflect significant sales in Rx prescriptions. Among the most frequently bought product on Amazon: electronics (44%), clothing, shoes & jewelry (43%), home & kitchen (39%), beauty & personal care (36%), books (33%), cell phones & accessories (28%), movie & television (25%), pet supplies (20%), sport & outdoors (17%), grocery & gourmet food (15%), automotive parts & accessories (13%), and baby products (9%).[8]

Photo Source: FinancesOnline.com

Writing for STAT, Erin Brodwin asked some key market analysts if Amazon is a disrupting force, or ‘just another mail order pharmacy’? The overall outlook doesn't look good for Amazon, at least in the near term. Although Amazon does address current consumer concerns over inconvenience and cost, as well as praise for injecting some price transparency into the space, Brodwin writes, "Amazon has yet to make a convincing case for why patients with an existing mail order or retail pharmacy would switch to its services."[9]

There is some speculation that Amazon might add to its pharmacy portfolio some brick-and-mortar-style pharmacies, such as placing the pharmacies inside Amazon-owned Whole Foods locations.[10] Doing so could certainly change the playing field even more so, but again, too soon to tell.

Jeffrey R. Lewis, President & CEO of the Legacy Health Endowment, expressed a cautionary tone: "As the new Amazon pharmacy races to tell the world why us, patients should take a step back. It is important to remember that all that glitters is not gold. For example, people taking HIV medications today are working with trusted pharmacy partners and pharmacists trained in dispensing these drugs, and the impact on patients with co-morbidities. So often, people living with HIV are seeing that pharmacist in person - why give that up?  And, as consumers, where you find the price of a specific medication at Amazon at a lower price, use your shopping power and take that price to your local pharmacy and ask them to match the price. Use Amazon - don't allow them to use you."

Amazon might be great for holiday shopping, or conveniently purchasing those everyday items, but right now it doesn't seem to be the choice for Rx prescription medicines. The HIV community, which has a long history with local pharmacies and pharmacists, could be even harder to persuade. Retail pharmacies and mail-order pharmacies have dominated this space for quite some time, and advocate concerns over privacy and profit-driven data practices could further sideline Amazon pharmacy's efforts to reach many consumers, particularly people living with HIV/AIDS. Time will tell...

[1] Amazon (2021, September 28). Amazon Pharmacy.  
[2] Anthony, James (2021). 74 Amazon Statistics You Must Know: 2020/2021 Market Share Analysis & Data. FinancesOnline. Retrieved online at https://financesonline.com/amazon-statistics/
[3] Anthony, James (2021). 74 Amazon Statistics You Must Know: 2020/2021 Market Share Analysis & Data. FinancesOnline. Retrieved online at https://financesonline.com/amazon-statistics/
[4] Anthony, James (2021). 74 Amazon Statistics You Must Know: 2020/2021 Market Share Analysis & Data. FinancesOnline. Retrieved online at https://financesonline.com/amazon-statistics/
[5] Laws, Jen (2021, May 17). Beyond Medication: Tech Advances in Care Delivery. Community Access National Network. Retrieved online at https://www.hiv-hcv-watch.com/blog/may-17-21
[6] Koulianos, Kollet, and Keri Norris (2021, June 30). Copay assistance should count as part of patients’ cost sharing for medications. STAT. Retrieved online at https://www.statnews.com/2021/06/30/copay-assistance-health-insurers-pbms-count-toward-cost-sharing-requirement/
[7] Japsen, Bruce (2020, March 23). Amazon Shifts Employees To PillPack And PBM RxAdvance. Forbes. Retrieved online at https://www.forbes.com/sites/brucejapsen/2020/03/23/in-pharmacy-move-amazon-shifts-employees-to-pillpack-and-pbm-rxadvance/?sh=3c1406234ddb
[8] Anthony, James (2021). 74 Amazon Statistics You Must Know: 2020/2021 Market Share Analysis & Data. FinancesOnline. Retrieved online at https://financesonline.com/amazon-statistics/
[9] Brodwin, Erin (2021, October 21). A disrupting force, or ‘just another mail order pharmacy’? How Amazon Pharmacy stacks up a year after launching. STAT. Retrieved online at https://www.statnews.com/2021/10/21/amazon-pharmacy-medicine-cvs-walgreens/ 
[10] Biswas, Urmimala (2021, June 17). Amazon's Physical Pharmacy Not a Grave Threat: 3 Stocks to Buy. Nasdaq. Retrieved online at https://www.nasdaq.com/articles/amazons-physical-pharmacy-not-a-grave-threat%3A-3-stocks-to-buy-2021-06-17

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.