Do you really think that Amazon can get their stock medications from just anyone? Do you think there is no oversight on this kind of thing? The DEA doesn't fuck around. They take all of this stuff very seriously.
Commingling medications? Really? In a pharmacy, medications are NEVER allowed to be commingled. If your medication is coming from two different manufacturers, or even the same manufacturer but the pills just look different, the pharmacy must put them in two different bottles to give to you. Stock bottle are not allowed to be mixed together. Ever heard of a recall on medications? That is exactly why. When a recall happens, they need tedious records of where every pill went.
When a prescriptions for a schedule II drug is filled, the pharmacy technician has to count the number of pills being filled twice. Then the pharmacist has to count the number of pills, and then backcount the stock bottle to make sure everything is kosher and no pills are missing.
I understand not everyone knows everything about the pharmaceutical industry, my wife is a pharmacist is the reason I know as much as I do, but to think that there is that little oversight on pharmaceuticals is ludicrous.
http://www.slate.com/articles/health_and_science/medical_exa...
https://abcnews.go.com/amp/Health/amazon-prescription-drug-p...
Everyone knows pharmacies are highly regulated, however Amazon has somehow managed to flaunt regulations so far without much consequences.
I could be wrong, as the first article states, Amazon skated by without so much as a warning while bodybuilding.com had to pay fines for selling the same steroids, but I would expect the FDA is able to throw their weight around more with Amazon now by shutting down their official pharmaceutical operation if they continue to make perscription medications available like this on their retail site.
Are there any exceptions allowed? I'm pretty sure I've had a major nationwide pharmacy give me a bottle with pills from two manufacturers in it. It had pills from the first in the bottom of the bottle, then a cotton wad on top of those, and the pills from the second manufacture on top of the cotton ball.
They opened the bottle when I went to pick it up, and pointed out what was going on inside and made sure I understood. They explained that they did not have enough pills in stock from the manufacturer they had used before for that prescription and refills, so filled out the order from a different manufacturer.
Perhaps it does not count as commingling because they divided the bottle into separate champers with a wad of cotton?
The disadvantage is that there are some leftover pills most of the time. E.g. you need 30 pills and there are only units of 20 available.
This is the exact reason why they count pills. You have a prescription for X pills, you get X pills.
It's been a while since I've had a prescription filled, but I think that in New Zealand it's the same. Most prescription drugs like opiate painkillers or antibiotics are counted and bottled.
Also, you may be able to build robots to dispense pills. But have you seen a European automated pharmacy supplier? Everything is automated. They dispense all the blister packs into a small cart that gets delivered to the pharmacy. In the end it does not matter if you supply a pharmacy with 2-20 medicines or a consumer with 1-10.
Yes, but is it worth the trouble?
Fentanyl is commonly carried in pharmacies but it’s not a commonly prescribed medication. Better examples would be adderall, vyvanse, norco and oxycontin.
I think it's just generally weird that a shipping and commerce company is taking interest in pharma to begin with. I think it SHOULD make users uncomfortable that a single company is potentially exposed to all these different vertices of user information. They know what you buy, soon they'll know what groceries people buy, what they read, what medicine they take which could in turn reveal metadata like sexual habits or genetic patterns.
It's weird.
I feel like it's more like Amazon just trying to monopolize everything. There are articles out there talking about getting Amazon-ed. Where Amazon would go in your industry and dominate you out the market. (https://www.forbes.com/sites/jamescahn/2018/04/24/dont-let-y...)
This is just a natural thing or the thing that Amazon does. Their modus operandi.
> what medicine they take which could in turn reveal metadata like sexual habits
They do recommendation system and I believe they sell sex toys so yeah... Alexia knows your kink already.
It's not weird but I think the better question is is this okay for one company to have so much power in so many area. Or at least I believe that's what you are trying to convey.
Sort of depressing, really.
Good grace. What a load of unnecessary bureaucracy.
Any other medication coming in blister packs wouldn't change a darned thing, unless you expect pharmacies to carry large quantities of sealed 5,10,15,20 etc etc dose packs. If they didn't, they'd still be breaking the sealed packs up and counting to match the perscribed amount.
Doctors are typically not experts in medications. Specialists probably know a lot about medications pertaining to their specialty, but asking GPs to know so much about a vast array of diseases AND the medications to treat them all, AND all interactions between medications is unreasonable. Doctors education is primarily in diagnosing disease. Pharmacists go to school just as long as doctors do (I think the major difference is pharmacists don’t typically do a residency after they graduate unless they are not planning to work in a community pharmacy), but their entire education is based around medications. Pharmacists are the medication experts. It’s a good thing that we have both looking after the healthcare of patients.
The supply chain integrity problems were allowed by Amazon because it benefited their bottom line. If they wanted it perfect, they could have made it perfect.
Remember when the eclipse was happening and they actually did a pretty good job of removing all glasses which weren't safe? They know where integrity counts, and I think when it comes to pharmaceuticals they'll know how to play this game clean. As another user commented: Amazon didn't get this humongous by making silly mistakes like this.
They also recalled a number of good units, which only sowed confusion and anger among buyers.
https://www.usatoday.com/story/money/nation-now/2017/08/14/a...
And it turns out some of the counterfeit glasses did get out to to buyers who thought they were purchasing legitimate units.
https://www.reuters.com/article/us-amazon-com-lawsuit-eclips...
Exploding hoverboard case shows how hard it is to beat Amazon in court
https://www.cnbc.com/2018/06/02/amazon-not-liable-for-explod...
https://news.ycombinator.com/item?id=17216972
> [T]here were so many cases of fires and explosions that Amazon had halted sales. [...] Fox's case was filled with testimony and evidence illustrating that Amazon execs were concerned about the hoverboards sold on its site. [...] [A]n Amazon vice president said the company had decided to halt sales of hoverboards and send a 'non-alarmist' email to existing customers [...] Fox received the email the next day. It referenced 'recent news reports of safety issues' and offered 'safety tips' for using the product as well as an option to return the device for a refund. There was no use of the word 'fire' or 'explosion.' Fox testified that if Amazon had said that 'they knew what they knew, I certainly would have gotten it out of my house.'
Only after people let them know they were not safe and not within a reasonable timeframe for people to order replacements.
They’ll invest the resources to ensure that doesn’t happen.
Amazon didn’t get big by being stupid.
Your point stands.
The bogus ones could then have been isolated and recalled, but this is not what happened.
1) Goggles used the existing supply chain. Which, as noted, was designed around the idea that customers would rather have cheaper things from any vendor that things from a specific vendor. Presumably the greenfield / acquired med supply chain is engineered around different desires and regulations.
2) By the time the goggle issue came up, inventory was already in the system. With some presumably co-mingled. I'm just saying I wouldn't want to be the DB analyst who got tasked with untangling that.
PillPack already has an established distribution network and prescription delivery licensing in 50 states. I don't know for certain, but I would assume that fake prescription medicine is a much bigger risk and would threaten the operation more than, say, fake batteries.
EDIT: i'm from outside the US, and after reading all the complains about delivery people throwing packages etc, i thought people don't trust delivery guys enough for medicine.
It appears i was wrong.
That you don't feel safe receiving your medicine being delivered last mile from some random UPS guy?
If this is what you mean -- I get my medicine by mail order from CVS. I cannot imagine now having to go to CVS every single month I get my medicine.
Anyone who could fix this problem will get her business in a heartbeat.
I'll be among the first to switch to AmazonRx.
I reject specific manufacturers from my CVS and get trusted manufacturers all the time.
Hard to do these days though. Teva is killing off a bunch of generics, Puerto Rico still a mess, weird shortages of common meds, etc. Sometimes I spend an entire day going around the city trying to find the specific generic which I'm used to. And then only get partial fills, etc.
Abruptly changing that filler could very well send an epileptic into a static seizure.
The potential liability they would be exposing themselves to if Amazon treated their drug supply chain the way they treat standard 'Fulfilled by Amazon' products would hopefully prevent something like that from ever happening.
It’s a big infrastructure lift so it’s still being implemented.
[1]https://www.fda.gov/Drugs/DrugSafety/DrugIntegrityandSupplyC...
Amazon isn't stupid: they know _exactly_ where they can play it fast and loose in order to maximize profit and where they must operate under strict regulation. This isn't the former.
Amazon does allow sellers to pay extra to keep their inventory separate. I don't know if the stuff Amazon sells is kept that way, but there's no guarantee it is.
That doesn't make sense. They would then need to make sure "Real Good Fakes" products are cheaper than what they send... At anytime "Real Good Fakes" can ask for his stuff back and that has to be "Real Good Fakes" stuff or there may be a big problem (used vs refurbished vs new).
They automate everything, there's no way there's no barcode for this kind of thing.
I got all my product from HP via Synnex, all factory sealed brand new genuine parts. The number of times I got burned by people leaving shitty feedback or returning stuff because what they got when they placed there order for the part I was selling was some knockoff that was close but not exactly it was high enough that I no longer sell on there.
The idea that FBA doesn't actually get me parts from the seller I picked has never crossed my mind. I certainly wouldn't have bought quite a few things if I knew that possibility existed.
Usually it would be many small quantities near me, and then one large one to the other coast which they would then distribute amongst their warehouses on that coast themselves.
So as the number of vendors stocking inventory increases, the cost to amazon to distribute inventory widely enough to hit SLAs goes down because more of the cost is borne by the vendors.
And what about "New" items missing packaging etc.?
https://www.inc.com/sonya-mann/amazon-counterfeits-no-starch...
Shipped and sold by Amazon.com means that the product is shipped and sold by Amazon Retail (via Vendor Central or Vendor Express) directly. Basically, the manufacturer sends product to Amazon.com at a set price through a traditional PO process. This inventory is commingled with all other FBA inventory.
...
Richard added, "[T]he consumer always thinks the chain is: Manufacturer » Amazon » Me. But the reality is that is pretty much never guaranteed. The only way that's guaranteed is if you find the manufacturer's listing on Amazon.com and buy via [F]ulfilled by Amazon directly from them, AND they happen to choose to opt out of commingled inventory. In every other scenario there's a chance that you get inventory that didn't come from the manufacturer."
no, they can't, and it doesn't have to be. that's how the FBA program works - when you send your stuff to amazon, they store it in their warehouse on the understanding that it's identical to any other example of the product it is listed as. You can't then turn around and say "i want all the ones i shipped you back", because you've told amazon that the products are interchangeable.
Ship in a crate of counterfeit widgets to mix into their fulfillment pool. Price them stupidly high so they don't actually sell.
Wait a few weeks, to let the inventory churn. There's a fair chance some of your items will actually be shipped out, and many more will be so mixed with turnover from real sellers that it will be difficult to trace back to you.
Then pull the listing and ask for "your" inventory back. Odds are, you'll get at least some legitimate products back, which you can then sell elsewhere at a significant discount.
The math for it to be economic is interesting and likely varies on product price versus counterfeit price, and the rate at which inventory turns over.
You almost certainly have, though you may not be able to tell the difference if you don't actively look for it.
Obviously, the USB drive stuffed in an SSD case is a fake. But that's not the only kind of fake going - printing "Seagate" on off-brand disks happens too, probably with much higher frequency. And cracking down on that would not just be harder, it would be a way bigger threat to Amazon's margins.
Hopefully the PillPack supply chain stays separate or separately monitored, but this wouldn't surprise me either - most cheap online pharmacies are selling real medicine at lower margins, possibly with worse quality control.
The gp merely asked for anecdotal data, nothing rigorous. By disagreeing, you are indirectly implying that the commenter is somehow incapable of telling fakes from the real deal.
How does anyone reliably tell fakes apart?
And Im concerned about knockoffs as well.
http://www.realfoodfakefood.com/real-food-fake-food-book-by-...
https://www.confectionerynews.com/Article/2017/02/08/Fake-Fe...
If there was any incentive to create and sell a knock off product, it is only increased when Amazon provides laxadasial environment.
There would be no reason to integrate prescriptions in with their warehouses, so I don't think one is going to change the other.
Do they all ready have a supply chain close to the requirements needed in healthcare ? For what ?
I would love for Amazon to come in and transform this space. There are lot of improvements to be made but all the well established players know those improvements but unless the regulations catch up its hard to innovate.
One thing Amazon might be able to do is to take a hit to their bottom line by essentially selling drugs at a loss and wait it out till they drive everyone out of the market and increase prices. But no one cares when the price of a book/toy increases by x%. Everyone cares when the price of a drug increases by the same amount. (https://www.cnbc.com/2017/04/03/mylan-hit-with-racketeering-...)
I'm not sure anyone thinks Amazon will allow 3rd parties to sell prescription medications. Although if they want to let me cash in on my dead mother's extra chemo meds and pain pills, let me know where to sign up.
They're not, though.
As an example, my wife is allergic to a filler ingredient in one generic manufacturer's version of one of her medications.
This is news to me. Can you link an article about it?
In no way I say it was fine, I'm just saying that Amazon will have time and opportunities to fix whatever counterfeits popup before hammer will go down on them.
It may also be they won't allow 3rd party markets into healthcare, we just don't know yet all the details.
Hope it never happens but if they do with pharmaceuticals what they did with everything else they sell, it's only a matter of time before users are physically harmed.
Let's be optimistic though, I hope this helps them finally get their shit together and control the rampant counterfeiting going on right under their nose.