Opinion: Pharmacist oversight must be built into prescription kiosks

STAT News · Feb 13, 2026 · Collected from RSS

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The next phase of direct-to-consumer health care involves several companies, including Amazon, beginning to fill prescriptions for common medications at electronic kiosks. These kiosks carry drugs used by millions of patients in the U.S. There are more than 20,000 prescription medications available in the U.S. market. Twenty percent of adults in the U.S. take five or more prescription drugs, while half report taking two or more prescription medications. Many also use over-the-counter medicines. Clinicians frequently manage patients whose complete medication profiles are dispersed across multiple prescribers, pharmacies, and retail channels. As a result, a patient’s full regimen — including prescription drugs, over-the-counter products, and dietary supplements — is not always visible at the point of care. These information gaps make it more difficult to anticipate clinically significant interactions or duplication of therapy. In this context, kiosk dispensing models that operate outside traditional pharmacist workflows may reduce opportunities to identify medication conflicts or counsel patients at the point of pickup. For people with complex or uncoordinated regimens, missed opportunities for review can increase the likelihood of therapeutic duplication, drug interactions, or suboptimal medication use — factors associated with avoidable adverse events in older adults and those with chronic conditions. In practice, the model is simple. A patient receives a prescription from a physician, whether in a clinic, urgent care, or telehealth visit, and instead of going to a traditional pharmacy, the medication is retrieved from a secure electronic kiosk. The process may take only minutes and can occur without direct interaction with a pharmacist. At first glance, that efficiency is appealing, particularly as community pharmacies face staffing shortages and increasing workload pressures. Yet even a brief exchange at the pharmacy counter often serves as a final checkpoint in the care delivery system, an opportunity to review new therapies, clarify dosing, identify potential interactions, or answer questions that may not have surfaced during a clinical visit. It is no surprise that unintentional injuries, including adverse drug events (ADE), rank as the third leading cause of death in the U.S. These ADEs are responsible for 1.5 million emergency department visits each year and nearly 500,000 require hospitalization, according to the Centers for Disease Control and Prevention. Combined with the issue of medication overload, the U.S. spends more money fixing medication-related problems (an estimated $528 billion in 2016) than on the medications themselves ($329 billion in 2016). Most people affected by ADEs are older adults, while the majority of Americans who take more than one prescribed medication daily are seniors and people with chronic illnesses. Fatal adverse drug events are more common in people aged 55 or older and are particularly severe for those over 75. To address the issue, the Center for Medicare and Medicaid Innovation (CMMI), which develops experimental models within the Medicare and Medicaid programs, launched a 2017 project called Enhanced Medication Therapy Management (EMTM). It provided financial incentives for private prescription drug plans — the entities that manage Medicare’s drug program — to develop solutions to prevent ADEs. One such solution involved pharmacists and physicians working together to improve coordination and assessment of all medications. The results were significant. A study published in 2021 examined how pharmacist-delivered medication safety reviews affected total medical costs, hospital stays, emergency visits, and death rates among Medicare Part D beneficiaries enrolled in the EMTM model. Those who received these comprehensive reviews showed notable improvements in all metrics compared to eligible beneficiaries who did not receive the EMTM services. Although the model ended in December 2021, it demonstrated that it is possible to reduce emergency department visits, improve patient quality of care, and save lives by lowering net Medicare expenses through addressing medication interactions before ADEs develop. While these results underscore the value of pharmacist-led interventions for people on multiple medications, they also illustrate a broader principle: Medication safety improves when patients receive timely, accessible support that helps them navigate increasingly complex therapeutic choices. It’s critical that the companies leading the way on digital pharmacy kiosks understand these risks — and the potential ways to mitigate them. Emerging digital tools can play a complementary role in this process by guiding patients toward safer decisions at the point of selection or use. When kiosks are purposefully designed to incorporate decision-support capabilities, they have the potential to enhance — rather than diminish — medication safety. A recent study involving older adults demonstrated that an interactive kiosk providing tailored, condition-specific information substantially improved the appropriateness of over-the-counter medication choices. Participants who used the kiosk were far less likely to select products with high anticholinergic burden, a known risk factor for cognitive impairment and falls in older adults. Importantly, the tool was rated as both usable and acceptable, suggesting that digital interfaces can support safer decision-making when integrated thoughtfully into the medication-use process. Another study focused on the implementation of a contactless prescription kiosk in a large health-system demonstrated comparable or improved performance relative to traditional counter service, including lower rates of prescription abandonment and high pharmacist-reported ability to address patient questions These findings indicate that kiosk-based dispensing, when paired with pharmacist oversight and clear triage pathways, can preserve core medication-safety functions while expanding access and convenience. Pharmacy kiosks are not inherently at odds with medication safety; their impact depends on how well they are integrated into pharmacist-led workflows and patient decision-support systems. Kiosks can expand access and improve convenience, but they must be supported by the clinical safeguards — such as pharmacist availability, medication review processes, and reliable communication pathways — that are critical for preventing adverse drug events. As these systems evolve, many kiosks will incorporate artificial intelligence to support medication review and patient guidance. AI tools may enhance screening for interactions or contraindications, but they must operate within pharmacist-led oversight to ensure accuracy and protect against algorithmic errors. Policymakers therefore have an opportunity to align innovation with safety by establishing baseline standards for pharmacist accessibility, medication review processes, data interoperability, and escalation pathways for clinical concerns. We propose that policymakers consider the following minimum pharmacist engagement standards for new kiosk technologies: Mandatory real-time access to a pharmacist. While not every patient will require counseling, kiosks should guarantee access to a licensed pharmacist whenever patients request assistance or when clinical concerns arise. Pharmacist verification of all new prescriptions. Given the risks associated with therapy changes and new drug starts, kiosks should adhere to the same verification requirements used in traditional pharmacy workflows to ensure that high-risk dispensing decisions involve pharmacist oversight. Clear escalation pathways for high-risk clinical scenarios. Kiosks should be designed to detect drug combinations or conditions with higher risks for adverse events and these high-risk scenarios should be automatically flagged for real-time clinician review or to be reviewed within 24 hours of dispensing. These guardrails would not limit market competition; they would ensure that any company entering the pharmacy space — whether Amazon or a local health system — meets the same expectations for patient safety. In a rapidly evolving health care marketplace, thoughtful regulation can support technological innovation while preserving the essential safeguards that protect people navigating increasingly complex medication regimens. Rather than slowing innovation, well-designed policy can help modernize medication access while maintaining the clinical oversight required to prevent avoidable adverse drug events. Ensuring that kiosk dispensing models evolve with, rather than apart from, pharmacist-led safety practices is essential to modernizing medication access without sacrificing patient protection. T. Joseph Mattingly II, Ph.D., Pharm.D., is an associate professor and vice chair of research in the Department of Pharmacotherapy at the University of Utah College of Pharmacy. Mark A. Munger, Pharm.D., is professor emeritus in the Department of Pharmacotherapy at the University of Utah College of Pharmacy.