Maren Chiu's mother-in-law moved downstairs into their Somerville home to be closer to family. She takes about eight medications a day, if you include vitamins.
And even though she's 92, she is fiercely independent.
"She likes to take care of her medication herself," Chiu says, "so she would sort them into the pill boxes, but I would look at them and see that sometimes there were two of the same pill in one, or something missing from another. Or she just wouldn't take them. And it was hard for us see whether she'd taken them or not."
Chiu says sometimes her mother-in-law seemed groggy, as if she were double-medicated. They tried different pill boxes, but nothing seemed to work.
And so they decided to try PillPack, a Somerville-based online pharmacy that seeks to help people manage multiple meds more effectively.
The medication shows up at their door once a month. It comes in a roll with individual tear-off packets that are time-stamped for the morning or evening.
"So there's no question about when you're supposed to take it," Chiu says, "what medicine you're supposed to be taking that time of day. It's all in the packages, sorted for you."
Chiu started her mother-in-law on PillPack about six months ago and insists she has noticed an improvement in her mother-in-law's health.
"There's just been fewer days where she seems off," she says.
It's ended up being cheaper than going to a pharmacy, though Chiu says saving money wasn't their goal.
And in fact, in some ways, she says it would be better if she could pick up these packages from a brick and mortar store.
"My mother-in-law is missing a little bit the personal contact of visiting the pharmacy, the pharmacists there knew her, and were able to pick up on things with medicine interactions," Chiu says.
But retail pharmacies aren't built for people with chronic conditions, according to TJ Parker, one of PillPack's co-founders.
He's a 31-year-old classically trained pharmacist who says historically, most pharmacies were designed around acute conditions.
"So you got sick, you went to the doctor, you got a prescription for penicillin, you filled it at the pharmacy, and you felt better in a week," he says. "And your interaction is now done with the pharmacy."
Parker says retail pharmacy hasn't caught up with the reality of people who take multiple meds, meaning patients are doing a lot of work themselves.
"They've gotta go to the store three or four times a month because the pharmacy can't even fill them the same day," he says. "Then they got to call their doctors constantly to get refills to make sure they don't run out of the medication. And then they're sorting this pill box once a week on Sunday nights."
PillPack is trying to streamline that entire process.
Parker tears off a package from a white plastic dispenser on the table.
"It literally says 8 a.m. on Monday, April 16th," he says. "It's all time-stamped, and that creates a system where we know exactly when you need your next pack, and you never have to worry about running out."
The goal is to create a simple, passive system for the customer. But Parker says that simplicity masks a back-end operation that's really complex. PillPack has created its own software system to manage everything from refills to batch packaging.
Stephanie Croteau, the director of PillPack's prescription services, leads us around an old mill building in Manchester, New Hampshire.
Here the company has hundreds of pharmacy technicians -- some who handle billing, others who take in customer service calls. Upstairs, you see rows and rows of prescriptions on shelves. It looks like a traditional pharmacy.
But then you notice these monster automatic sorting machines.
"Basic setup is the computer that kind of correlates to the machine and we have technicians that work two machines at one time," Croteau says. "So these are coming out one packet at a time, spinning on this roll."
Corteau worked at a large retail pharmacy for five years before joining PillPack. She says the premise at PillPack is that there's a lot of pre-work that can be done on the software side.
"We're able to coordinate those refill timelines so that they're happening at the same time," she says.
PillPack has tens of thousand of customers, but would not disclose exact numbers. And it's raised over $100 million in venture money.
But fundamentally, PillPack's success depends on changing customer behavior.
"Behavior change is hard in any aspect of one's life," says Steve Kraus, a prominent health care investor with Bessemer Venture Partners in Cambridge. (His firm does not invest in PillPack.) "But in particular in health care, it's been very hard to change behavior."
Kraus says PillPack's innovations in packaging prescriptions are unique, but if it works, "I think the bigger players, the Express Scripts and the CVS Caremark, who also have mail order delivery pharmacies, will just replicate that model."
Kraus says he's had conversations with some of the larger pharmacy benefit managers and they are experimenting with packaging that sounds similar to PillPack.
He's also not sure that an online pharmacy is a defensible long-term strategy.
"If Walmart, which is a huge physical pharmacy in stores across America, or say if Amazon, as has been rumored, gets into online pharmacy, maybe, I think either one of those companies could very quickly outgrow anything that a small young startup could do," Kraus says.
But PillPack says its unique competitive edge is not the package itself, or even the online pharmacy; it's the homegrown software, the back-end that nobody can see. Most pharmacies run on a patchwork of third-party software, and executives at PillPack say it's not easy to scale, unless you have your own software.
This segment aired on January 26, 2018.