I ❤️ Pillpack.

They make my life easier.

But they also make my doctor's job better.

And they save my health insurance company money.

Patient. Doctor. Health Insurer. All win.

What I don't understand is why anyone is filling a prescription any other way. Every single other way is worse on each of those metrics. Ease. Compliance. Cost.

Ok, a few caveats.

  1. This is for longer term medications, not for antibiotics or something that used for an acute illness.
  2. When I talk about lowering cost, I'm talking about overall cost – including the cost of the doctor's time trying to figure out if I'm taking the right dose, and then adapting the medication routine with imperfct information, and the resulting care improvements that come from an accurate understanding of the actual compliance with the prescription routine relative to illness progression. Said differently – if I'm taking the right meds, at the right frequency, the doctor will more accurately diagnose and treat, which lowers overall treatments costs.

When I was doing plain-old-mail-order, I'd get a pile of pills. I could spend time on Sunday sorting them into pill cases, or I could hope I take the right things, on each of the right days. This last bit of hope is unlikely. I barely remember whether I've brushed my teeth or showered 10 minutes after having done so.

When I was doing mail-order, I'd get a new order, but still have lots of pills left over from the previous order. Was I skipping days? Or, did the shipment come early? Not only were there no dates, the shipment would come from "CVS Caremark" but it turns out I'd have to call my health insurance company, not CVS to deal with anything.

It was confusing. At least to me as the patient.

Confusing is draining. Each patient has to create their own system for managing... or not.

Famously, Steve Jobs wore black turtlenecks every day. Why? I think he just liked it, and the idea of a uniform. But there's a bit of legend that he wore the same thing every day to reduce the cognitive load of deciding what to wear each morning.

So, creating a system to track the meds I take... that's a lot more cognitive load than deciding what to wear! Remembering to pack the right meds for a trip. Or, taking the time to put meds into packs for the week. All of that takes time and energy. Time and energy that are better spent elsewhere.

The other day another doctor of mine (now former doctor of mine) sent a prescription to mail-order. I had specifically told his office – whatever you do, don't send this mail order. (They're former not because they made a mistake, but because they refused to correct it and made me deal with the insurance company. Yes, I'm a prima donna.)

In the interim, when I was trying to get the mail-order prescription undone and sent to Pillpack, I kept imagining the overhead I'd have to take on for three months and after two years of pandemic bullshit, it felt overwhelming. I'm sure I'm more sensitive to overwhelm at this point... but still it was quite clear.

The value of Pillpack is absolutely outstanding:

  1. I don't have to think. They pack up my meds in a single packet for each time I need to take meds. In fact, I have one vitamin I take every-other day, and that's in every other day's packet. I don't have to fumble around with multiple pill bottles. I don't have to wonder... is today the day for the vitamin or is today the off-day?
  2. There's a date and time-stamp on it. It's easy to be compliant with my doctor's instructions. In fact, I know in the near two years I've been using them, I missed my meds only one day. Because I have the pack from the day I missed.
  3. When I travel, I simply grab the packs for the dates I'm away. So simple.

Each of these things add up. And, on top of them all, I can reply to any message I get from Pillpack and they get it. No more "[email protected]", then scouring websites for phone numbers, etc. In fact, while I was writing this post, I was just chatting with a human to get a question answered about my next order.

Couldn't be easier.

And, easier is so much better.

Final Word

That point #2 above about overall cost of care. Why are people still stuck trying to figure out medical adherance... shouldn't we be trying to get better at care? Solve problems "higher in the stack"? If we're struggling with "do patients take the right meds, on the right schedule" we're wasting time that could be used for solving the "what the fuck is going on with this patient?" questions.