"There is a lot of difference, but in the end, there are not a lot of differences," Bohlmann said when asked if packaging medicine was similar to shipping books, from an engineering standpoint. As the company's machines whirred and whooshed in the background, Bohlmann paused only a second, knowing the difference can be life or death if Grandma gets the wrong medicine.
"There are a lot more regulations and double-checks" when it comes to medication, Bohlmann said. "If you don't get your book from Amazon, who really cares? Well, of course, the customer is bothered and Amazon cares because it feels the need for customer service. But this is a lot more sophisticated because you're dealing with medicine. And the potential for us is being the Amazon of pharmacy."
For years, daily medication has often been shipped to nursing homes in 30-day packages called bingo cards. The attending nurse remains responsible for unpacking each day's pills, usually into a paper cup. Some seniors have 20-plus daily doses and the nurse has to keep track.
If a patient's prescription changes or the patient leaves the facility, remaining pills are supposed to be thrown out, wasting money and perhaps polluting nearby waterways.
With pharmacists taking and checking orders, Remedi's machines create a personalized package of individually wrapped medicines that is delivered daily, with only a one-day cushion. At six spots along the way, photographs are taken of the medicine or the packaged pill (with a bar code) to create a record.
The idea is to reduce cost and waste, save time for nurses, and improve safety. Remedi's robotic Paxit machines, which have their own patents pending, can service 10,000 patients per day. They cost $1.3 million per pair and they always come in pairs, just to make sure one is always operable since patients need medicine every day.
Remedi is a private company, with 650 employees working in Maryland, Ohio, Virginia, and Pennsylvania. Chief executive officer Michael Bronfein declined to reveal revenue figures other than to say the company is profitable.
Before Bronfein took over as CEO, Remedi - like the dominant player in the sector, Omnicare Inc. - ran afoul of federal regulators. A whistle-blower lawsuit said Remedi's affiliate, Woodhaven Pharmacy Services in Baltimore, violated federal laws in 2006 and 2007 by failing to credit government health-care programs for medications that were dispensed to patients in long-term care facilities and later returned and redispensed to other nursing-home and assisted-living patients. The company paid nearly $1.3 million in 2010 to settle the case.
Omnicare has $6 billion in annual revenue, and another competitor, PharMerica, generates about $1.8 billion. But Bronfein says the sector is ripe for disruptive innovation.
"Health care," Bronfein said, "is very slow-moving in the way it changes."