A Pack of Trouble
08/30/25 Filed in: Medical Questions | Tech Trouble
Amazon has taken over a service that used to make my life easier—and ruined it.
For several years I have used PillPack.com as my pharmacy for everything except short-term prescriptions. It has not been a perfect service, and since Amazon took over the company in 2018 it has deteriorated. But now that Amazon has completed merged it with its Amazon Pharmacy, it looks like they are bent on destroying what made it useful.
My physicians have me taking what some might think of as a lot of pills, not to mention a weekly “injectable” and a monthly injection. Two of the meds count as “controlled” substances. (That sounds more exciting than it is: one is a decongestant, the sort of thing you don’t need a prescription for, but now have to sign for. The other keeps me from sleeping all day. Don’t think “uppers.” I don’t get a jolt; I just don’t want to take a series of naps as soon as I’ve finished my first cup of coffee.) Others, such as iron pills and vitamin D, do not require a prescription, though I take them on the doctors’ instructions. I am happy with how I feel on this treatment regime. The physicians are happy with the numbers on my lab tests. I don’t have any trouble taking the pills or giving myself the injections. I don’t have any side effects that bother me all that much. Yet, my meds eat up hours of my time and give me awful fits of anger and frustration. The problem is not the meds, which keep improving. It is getting the meds and keeping track of them.
Usually the source of the trouble is an insurance company or a “prescription benefits manager,” but that problem seems to be insoluble. Now and then a pharmacist makes a mistake or doesn't understand the rules. But much of the trouble stems from the difficulty of sorting 12 different pills, some of which I take once a day, some twice a day, some once a week. Some I take in one-pill doses, some in two-pill doses. I used to spend part of every Sunday opening pill bottles, putting pills into the right compartments of a twice-a-day seven-day pill box, and hoping that I would sort them correctly and not spill a bottle of pills (especially not the tiny white ones!)
Then I heard about a technology that would allow me to abandon that ritual. Using it, all a patient’s meds are pre-sorted into rolls of individual packets, each clearly marked with the date and time that set of meds is to be taken. This system is both more convenient and safer the old system. Juggling a lot of little orange bottles, one can easily skip a medication or take one twice. Moving pills from the bottles into a pill box with 14—or more—compartments is time consuming and again invites missed or doubled doses. (Need I mention that patients taking a number of different meds are often older people whose brains, eyes, and fingers may not be ideally suited to the task?) I asked about investing in the tech—no luck—and resolved to sign with any pharmacy that began offering it.
When PillPack.com worked as it was supposed to—and, sadly, it often didn’t, especially after Amazon acquired it—the technology lived up to its promise. Instead of lots of bottles or blister-packs of pills, I received a roll or two of packets, each marked with the date and time the meds were to be taken. If I just tore the next packet off the roll each time I was supposed to, I was taking my meds correctly—no sorting pills into a multi-dose box or shuffling bottles and hoping I hadn't missed one or used one twice.
Now Amazon has integrated PillPack completely into Amazon Pharmacy. Despite operating PillPack.com for more than six years and being able to draw on all the technology developed and all the experience gained in their other operations to improve it, Amazon seems instead bent on making it less useful than it was before.
My last roll of packs from PillPack.com included 12 different meds—everything I take that isn't injected or inhaled—in one roll of packets.Now I am on Amazon Pharmacy’s system. I now deal with a less bulky rolls of packets, three pill bottles, and box of blister packs. Why? The answer varies with which of Amazon’s reps I chat with. Amazon Pharmacy refuses to include even the lowest level of controlled substance, such as decongestants, in packs. Yet my experience with PillPack.com shows that they can. It will not include meds that are not taken daily, because, the agents say, their system is not programmed for it. Amazon has owned the code that allowed PillPack.com to do it for the last seven years. And they will not include “lifestyle medications” in packs, though whether that term applies to the Vitamin D2 or to the beta-blocker my cardiology prescribes is a matter that varies with the agent.
That Amazon has decided to ruin the PillPack service seems clear. It is another example of what Cory Doctorow calls enshitification. Amazon has replaced something that served the customer well with something that is worse in every way. I assume they see more money in doing it this way. They will eliminate the expense of putting weekly meds or controlled substances into packs, and, because there is meager competition in the field, people will go on using them even as the service deteriorates. (They first bought and then shut down what would have been the alternative to a pill pack service Amazon Pharmacy created from scratch for a reason, and the reason was clearly was not to learn how to provide patients with meds in the most convenient form.) Many of us go on using Amazon for other things even as the search results more and more often return something Amazon makes a bigger profit on before the thing we asked to see. And we do that because there doesn’t seem to be a site we can go to instead.
There are no high-profile alternatives to Amazon Pharmacy as a PillPack.com replacement. CVS recently stopped offering a pill pack service. Among the smaller operations I have not found one that will both put all my pills in packets and fill my other prescriptions. The one I find most promising is MedBox, which will put all the pills in packets, but they have warned me that they may not be able to supply an injectable drug. So, my doctors and I will be dealing with two pharmacies, instead of one.
The solution to problems like the deterioration of Amazon’s search results and its destruction of PillPack.com is completion. I should be able to transfer my prescriptions to a full-service pharmacy that will put all the pills in packets, just as should be able start searching for other products on a site that shows me what I ask it to show me. But competition to Amazon is vestigial. If the free market to work, we need more than one big player. It is time to make markets competitive, and that means making sure there are competitors. Companies should not be allowed to simply buy up their rivals, and wherever one corporation controls too much of a sector, such as eCommerce or online search, it should be broken up. The medication for this problem is tougher antitrust laws and the rigorous enforcement of them.
For several years I have used PillPack.com as my pharmacy for everything except short-term prescriptions. It has not been a perfect service, and since Amazon took over the company in 2018 it has deteriorated. But now that Amazon has completed merged it with its Amazon Pharmacy, it looks like they are bent on destroying what made it useful.
My physicians have me taking what some might think of as a lot of pills, not to mention a weekly “injectable” and a monthly injection. Two of the meds count as “controlled” substances. (That sounds more exciting than it is: one is a decongestant, the sort of thing you don’t need a prescription for, but now have to sign for. The other keeps me from sleeping all day. Don’t think “uppers.” I don’t get a jolt; I just don’t want to take a series of naps as soon as I’ve finished my first cup of coffee.) Others, such as iron pills and vitamin D, do not require a prescription, though I take them on the doctors’ instructions. I am happy with how I feel on this treatment regime. The physicians are happy with the numbers on my lab tests. I don’t have any trouble taking the pills or giving myself the injections. I don’t have any side effects that bother me all that much. Yet, my meds eat up hours of my time and give me awful fits of anger and frustration. The problem is not the meds, which keep improving. It is getting the meds and keeping track of them.
Usually the source of the trouble is an insurance company or a “prescription benefits manager,” but that problem seems to be insoluble. Now and then a pharmacist makes a mistake or doesn't understand the rules. But much of the trouble stems from the difficulty of sorting 12 different pills, some of which I take once a day, some twice a day, some once a week. Some I take in one-pill doses, some in two-pill doses. I used to spend part of every Sunday opening pill bottles, putting pills into the right compartments of a twice-a-day seven-day pill box, and hoping that I would sort them correctly and not spill a bottle of pills (especially not the tiny white ones!)
Then I heard about a technology that would allow me to abandon that ritual. Using it, all a patient’s meds are pre-sorted into rolls of individual packets, each clearly marked with the date and time that set of meds is to be taken. This system is both more convenient and safer the old system. Juggling a lot of little orange bottles, one can easily skip a medication or take one twice. Moving pills from the bottles into a pill box with 14—or more—compartments is time consuming and again invites missed or doubled doses. (Need I mention that patients taking a number of different meds are often older people whose brains, eyes, and fingers may not be ideally suited to the task?) I asked about investing in the tech—no luck—and resolved to sign with any pharmacy that began offering it.
When PillPack.com worked as it was supposed to—and, sadly, it often didn’t, especially after Amazon acquired it—the technology lived up to its promise. Instead of lots of bottles or blister-packs of pills, I received a roll or two of packets, each marked with the date and time the meds were to be taken. If I just tore the next packet off the roll each time I was supposed to, I was taking my meds correctly—no sorting pills into a multi-dose box or shuffling bottles and hoping I hadn't missed one or used one twice.
Now Amazon has integrated PillPack completely into Amazon Pharmacy. Despite operating PillPack.com for more than six years and being able to draw on all the technology developed and all the experience gained in their other operations to improve it, Amazon seems instead bent on making it less useful than it was before.
My last roll of packs from PillPack.com included 12 different meds—everything I take that isn't injected or inhaled—in one roll of packets.Now I am on Amazon Pharmacy’s system. I now deal with a less bulky rolls of packets, three pill bottles, and box of blister packs. Why? The answer varies with which of Amazon’s reps I chat with. Amazon Pharmacy refuses to include even the lowest level of controlled substance, such as decongestants, in packs. Yet my experience with PillPack.com shows that they can. It will not include meds that are not taken daily, because, the agents say, their system is not programmed for it. Amazon has owned the code that allowed PillPack.com to do it for the last seven years. And they will not include “lifestyle medications” in packs, though whether that term applies to the Vitamin D2 or to the beta-blocker my cardiology prescribes is a matter that varies with the agent.
That Amazon has decided to ruin the PillPack service seems clear. It is another example of what Cory Doctorow calls enshitification. Amazon has replaced something that served the customer well with something that is worse in every way. I assume they see more money in doing it this way. They will eliminate the expense of putting weekly meds or controlled substances into packs, and, because there is meager competition in the field, people will go on using them even as the service deteriorates. (They first bought and then shut down what would have been the alternative to a pill pack service Amazon Pharmacy created from scratch for a reason, and the reason was clearly was not to learn how to provide patients with meds in the most convenient form.) Many of us go on using Amazon for other things even as the search results more and more often return something Amazon makes a bigger profit on before the thing we asked to see. And we do that because there doesn’t seem to be a site we can go to instead.
There are no high-profile alternatives to Amazon Pharmacy as a PillPack.com replacement. CVS recently stopped offering a pill pack service. Among the smaller operations I have not found one that will both put all my pills in packets and fill my other prescriptions. The one I find most promising is MedBox, which will put all the pills in packets, but they have warned me that they may not be able to supply an injectable drug. So, my doctors and I will be dealing with two pharmacies, instead of one.
The solution to problems like the deterioration of Amazon’s search results and its destruction of PillPack.com is completion. I should be able to transfer my prescriptions to a full-service pharmacy that will put all the pills in packets, just as should be able start searching for other products on a site that shows me what I ask it to show me. But competition to Amazon is vestigial. If the free market to work, we need more than one big player. It is time to make markets competitive, and that means making sure there are competitors. Companies should not be allowed to simply buy up their rivals, and wherever one corporation controls too much of a sector, such as eCommerce or online search, it should be broken up. The medication for this problem is tougher antitrust laws and the rigorous enforcement of them.
