Delivering Medications – An Example of How Autonomous Vehicles Can Improve Our Lives and our Economy

I believe we are missing huge opportunities to improve our daily lives, our economy, and our culture. So far I’ve focused on the feasibility of Autonomous Vehicles, techniques for improving transportation, and motivation for new approaches.  I have a lot more ideas to share on those topics, but I also want to talk about how I believe a new transportation system can, and should, improve our lives, our economy, and our culture. Let’s start with a, relatively, simple example: taking prescription pills.

Recently we visited my father-in-law who is recovering from a serious infection. For the first time in his life he has to take several pills each day. A Certified Medication Associate brings in the pills and watches him to be sure they are swallowed.

My father, for the last few years of his life, was taking 21 different pills, some daily, some more frequently, and one only weekly. The pills had to be taken at different times of the day: before breakfast, with a meal, between meals, with liquid, before bed, etc. He had one of those pillboxes with 28 compartments, seven days a week and four times a day.

His prescriptions came with a 90-day supply of pills, so once a week he had to parcel out the pills into the correct compartments. This was ok while he had all his faculties, but as his memory started to fail, he would forget to take pills sometimes, as all of us do. But more seriously, he got to the point he couldn’t parcel out the pills. So a nurse had to come out once a week and fill his pillbox. But that still didn’t help when he forgot to take them.

Why do we get a 90-day supply of pills? There are a number of reasons, because this is a complex system, but a key one is the transportation system. The transportation system, whether US Mail, or one of the package delivery services, or driving to your local pharmacy, establishes the cost of delivering the pills, roughly $1 - $5 per delivery.

So if you are a mail order pharmacy you want to space out the deliveries as much as possible to reduce your overhead for shipping and handling, to make you more competitive with drive-up pharmacies. (Other factors include getting paid more up front with a larger order.)

With over 4 billion new prescriptions written every year, our transportation system couldn’t handle a much more frequent delivery schedule: imagine that everyone received pills weekly, or even daily – the transportation system would be overwhelmed.

So if you are living in a care situation, such as a hospital, nursing facility, etc., you have someone deliver, administer, and document your pills (depending on local regulations). If you are on your own, you have to manage your own pills.

What if the cost of delivering a dose of your medications were 1¢. Note that is less per day than $1 for a 90 day supply! Now we could have a completely different way of administering pills, not only more efficient, but managing the whole process for you.

At the appropriate time each day you get a delivery of the pills your supposed to take. They can arrive wherever you happen to be, even if you are visiting in someone’s home, or on vacation, or at a restaurant, or at work.

If you are prone to not taking your pills there are many innovative approaches. I’ll mention a few to give you the basic ideas: we could electronically connect you to a caregiver who can talk with you to encourage you to take your pills, or we can do it with a video connection so they can see you actually take them. The communications can either be through the delivery vehicle (it needs to have video and communications capability anyway to navigate and be directed), or through your electronic personal assistant (e.g., software on your smart device). Or if all we need is a record of your taking them, the vehicle can wait until you confirm that you have taken the pills. Matching the image of the pills taken with the prescription is also an important safety check.

Now we don’t have to worry about forgetting to take your pills, or forgetting to bring them with you when you go out, or running out of pills. Other benefits include only taking the medication as long as you need it – many times I’ve gotten a 90 day supply of a new medication only to find that it doesn’t work for me, or I don’t tolerate it. Other issues improved are: expiration, returning unused medications, recalls, other changes in your prescription, etc.

How often have you gone to the pharmacy to get a prescription only to be told that they are out of stock, or that they can only give you a one week supply, “so please come back.” This inexpensive transportation means that your local pharmacy doesn’t need to stock all the different medications, they can be delivered from wherever there is stock available.  This reduces the cost of wholesale distribution and stocking. just-in-time inventory management.

The new transportation system would also allow more sophisticated medical treatments, such as “titrating,” that is trying different dosages and monitoring the results until the optimal one is achieved, or having different dosages at different times.

If you take several pills at once, as many people do, including me, the cost of delivery is reduced even further because it is divided among all the different pills taken at one time.

How could it be this inexpensive to deliver one or a few pills? Let’s look at the components of the transportation system needed for delivery of pills. First consider the current system: if you drive to the pharmacy, the cost of operating your car is on the order of 50¢ per mile, so if you drive 5 miles to and from the pharmacy, that’s $2.50. If the Post Office delivers your pills you can see the amount of postage, more than $1, and the Post Office is probably losing money. Other carriers cost even more.

Now let’s look at a simplistic cost calculation for the new transportation approach:

1. The Mini-Mobility Vehicle carrying the pills is very small, less than 1 pound and is simpler than the automated helicopter I mentioned above,which costs on the order of $100 to purchase. If you use 10 minutes of its time, with 50 trips a day, and 365 days in a year, that comes to .05¢ (that’s $.0005), only 1/20 of the 1¢ I discussed above as the threshold for such an innovative system.

2. The larger Convoy Vehicle that carries the Mini-Mobility Vehicle might cost $1,000, but it can carry 100 MTV’s (that's less than a person weighs, so this could be like a Personal Transport Vehicle), so the allocated cost is even less, by a factor of 10

3.     What about the cost of fuel for these vehicles: the new system will be much more efficient that current cars, but even my Chevy Volt gets about 40 miles on 10 kWhr (thousand-Watt-hours) of electricity, so at 20¢/kWhr that’s only 5¢/mile, and that could carry 500 MMV’s, so our 5 miles comes to .05¢ again.

So the cost for our new transportation system vehicles and energy is on the order of .1¢ (that’s $.001) for delivery. I haven’t included the cost for the A-Ways, etc., but we will see that those will be less expensive than current highways, and we are using them more efficiently – say 500 MMV’s in a Convoy Vehicle that is comparable in size to an automobile today.

Even if I’m being optimistic by a factor of 5, we are still below the 1¢ transportation cost threshold.

The overall costs for this new system are much less than the current system because although the pharmacist still needs to authorize the initial prescription, they don’t have to handle the pills, so we are taking less of their time – automatic pill dispensers are used in all large pharmacies anyway. And you don’t need a clerk to check you out of the pharmacy, or all the space for you to stand in line, etc. which saves several dollars, thus swamping the cost of the transportation system. J

The details of this approach and analysis make for interesting discussion. But my point is that if we had a much more efficient transportation system, all sorts of improved services are available to reduce our costs, improve our lives, and improve our safety. (One of my favorite statistics is that if you drive 5 miles to buy a lottery ticket, you are more likely to die in a car crash than to win the lottery.)

This solution certainly would have helped my father, and it would help me – I have finally had to resort to one of those 7x4 pill cases, as it got too complicated to keep track with only 1 compartment for each day. Yet I still forget to take my pills sometimes, sigh.

In coming posts I will examine other innovative applications driven by a dramatically more efficient and safer transportation system. Some of these will also show further improvements in the basic pill delivery application I’ve outlined here.