Actual shipping costs aside, being a delivery channel is way harder for drugs than for most other things.

Amazon is reliable, sure, but what do they have - 99.9% fulfillment, 99% on time, 99% with authentic products, 97% of listed products in stock? Those are guesses, but apply those numbers to delivering vital daily medicines and the problem becomes pretty obvious.

Keeping in-stock rates high and "on time with authentic products" rates near 100% is not an easy task. It's not something pharmacies do perfectly either, but their shortages are generally at a store level rather than national, and they're not asking people to completely switch delivery mechanism to trust a space with online one provider.

I agree in general, reliability is very important. But the reliability is not 100%, even in traditional pharmacy chains, at least from my experience(not for heart medication, though). And maybe, being an online subscription service(i.e. central warehousing and knowing orders in advance - predictability ) makes it easier, cheaper to guarantee that reliability ? maybe even with some errors in the system ?

You can today get a lot of prescriptions mailed to your home just from the local pharmacy like CVS so that's not going to be such a huge advantage. Also pharmacists can have pretty important roles educating people about harmful interactions and answering questions which is something where an online prescription fulfillment service might have a hard time.

True, maybe shipping was a constraint. can any random guy ship drugs ? isn't some special supply chain required ?

Another guess is that changing habits(especially since buying drugs is an infrequent event, and that we're dealing with seniors) and creating trust we're other reasons.

PillPack is basically a supply chain company - it's not an easy field to get into. I don't know if "who can ship these" is a big hurdle, though. Possibly a bigger issue is "doctors and patients are used to calling prescriptions in to pharmacies".

But the main issue with drug delivery is the need for reliability; you can't have somebody's heart medication ship out late or get lost in transit, basically ever. And if you change offerings or go out of stock on specific products (which most retailers do often), you'll quickly be seen as an unreliable way to get any kind of regular medication.

Plus, you can't let any fakes or low-quality products into your supply chain - so sourcing new suppliers is hard, but running out of suppliers for any single product is a crisis.

So being an online seller for use-as-needed prescription meds might be easy, but the bulk of the money is in people taking drugs daily, and that stuff is damned hard to offer.

At a previous employer, I attended a briefing for our health insurance switching to a mail order pharmacy. Granted this was years ago but the amount of confusion and frustration around the signup process, scheduling, skepticism about delivery times/reliability, etc were numerous. To me, it couldn't have been an easier process. For some people (especially retirees), going to the local pharmacy is part of a regular routine that is not seen as a inconvenience at all.

Basically, the largest potential market for you is not tech savvy at all and makes it hard to convert.

I don’t get many prescriptions so when my doc writes one I don’t care who fills it. She couldn’t send it to a random mail order pharmacy, I had to pick one.

I think there’s a big opportunity for insurers to pick a default mail pharmacy that customers out of. So depending on your insurer, the EMR automatically files with a pharmacy you don’t care about and mails it to you within 24 hours.

My employer-provided insurance is UHC, which has a preferred partner situation with OptumRX, a mailorder pharmacy. They give you better rates on your prescription copay if you use them. The mail turn-around time is not great though. It's good for long-term prescriptions, shitty for short term like antibiotics.

My doctor sends short term stuff to a local pharmacy for me to pick up, and my daily long term pills to Optum, who charges my CC and mails them to me. They take about a week to arrive, but you can set it up so they automatically recur, so you always get your next 90 days before your current pills run out.

> there’s a big opportunity for insurers to pick a default mail pharmacy

Looks like it’s already happening, albeit in an opposite direction, with Aetna acquisition by CVS.

Insurers already do that and also limit how many prescriptions they will cover outside of mail order delivery.