So, you need to pick up a prescription. During lunch or after work you’ll go to the nearest pharmacy, where you’ll stand in line at a counter. The pharmacist will ask you to wait 20 minutes, so you’ll contemplate a new shampoo or flip through magazines. Maybe you’ll leave with your pills, but maybe the pharmacy won’t have your meds in stock.

Or: Maybe you’ll be able to use an app, or a slick chat interface, or pill bottles with sensors. Those are the kinds of things two startups—Capsule and Round Refill from Circadian Design—are working on. Both companies also deliver prescriptions, and their approach could save billions in healthcare costs.


The key to that savings lies in cracking medication non-adherence, which can be intentional (patients deliberately skip medication for logistical or financial reasons) and unintentional (they forget). According to a study led by Seth Heldenbrand at the University of Arkansas, half of all US adults fail to take meds when they’re supposed to. Someone who skips blood pressure medication is more likely to develop a heart condition that costs far more to treat. Nationwide, non-adherence incurs between $100 billion and and $300 billion in avoidable costs each year.

Rather than invest in physical locations, Capsule CEO Eric Kinariwala decided to bulk up on software, and hired the former head of mobile engineering at Foursquare to build a clever inventory management system that uses customer demographics, seasonal factors, doctor input, and information about commonly combined medications to ensure that Capsule’s fulfillment center in Manhattan always has the right meds in stock. Although the company has a small storefront in the Chelsea neighborhood, most people will use an app to chat with pharmacists, schedule deliveries, and learn what a medication costs before filling the prescription. If Capsule works as promised, getting a prescription filled will feel less like Rite-Aid and more like Uber. “Capsule has taken note of what is really annoying about the current pharmacy experience, and taken a little bit of frustration out,” says Heldenbrand.


Circadian Design, on the other hand, is targeting unintentionally non-compliant patients. Its “smart bottle” has a silver dollar-sized circuit board, accelerometer, Bluetooth module, and several LEDs. The hardware, which costs you $10, communicates with an app that tracks your prescription. A ring of blue lights provides what product head Matt Crowley calls a passive but persistent reminder to take your meds. “We wanted to turn it into something that doesn’t exist for a single point in time,” he says. Open the bottle and the sensors ping the app, which notes it in a log and alerts you when it’s time to refill.

Capsule and Circadian aren’t the only companies rethinking the pharmacy model. PillPack mails individual packets of daily medications. PillDrill monitors prescription levels and monitors patient adherence using RFID technology. Designers love the idea of rethinking the drugstore experience—especially in a time when basic services are becoming increasingly streamlined. “From a consumer perspective, you compare with the experiences of other services,” says Jonas Högland, design director at global design consultancy Fjord. Once you’ve hailed a ride with your phone, it’s hard to go back.

For Capsule, Circadian, and other newcomers to the pharmacy-of-the-future category, success will hinge on their services being as seamless and error-free as possible—a major challenge, when you consider the diverse makeup of prescription drug users. Adolescents and the elderly are the most common culprits when it comes to non-adherence, but Heldenbrand says risk factors like complex medication regimens, poor health literacy, and lack of family support can affect adherence rates in patients of all ages, genders, races, and classes.


Who, then, should these services target? Heldenbrand says the fact that both Circadian and Capsule rely on an app could result in their earliest users being young and tech-savvy. If their customer base expands to include the elderly—whether by word of mouth, or designing for this demographic, specifically—these companies could wind up serving the two largest non-adherent groups. As for staying power, Heldenbrand says “the most effective tool known to improve medication adherence is education by a healthcare professional—more than one, usually.” To that end, both Capsule and Circadian offer communication with users’ doctors, in the form of a report on completed deliveries (Capsule) and an auto-logged record of pills taken (Circadian).

For now, the companies’ operations are limited to New York and California. But if they can expand, those lines at the pharmacy could get a lot shorter.

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Pharmacies Are Awful—But These Startups Could Fix Them