It looks like an oversized cash machine. But instead of spitting out greenbacks, it dispenses prescription medicine.

For Michael Powell, who slipped his debit card into one of the machines at North Memorial Medical Center recently, the on-site convenience can't be topped.

"It took two minutes, maybe," he said. "If I go to my drug store I'll wait at least a half hour."

The Eden Prairie company InstyMeds is bringing vending machine convenience to the world of medicine. The number of the machines has doubled in the past three years, with 200 installed in 33 states and the District of Columbia, mostly in emergency rooms and urgent care centers.

Advantages include a reduced risk of giving a patient the wrong drug, according to the company. But pharmacists also point to limitations, such as the machine's inability to counsel patients.

"It's not quite as seamless as going to a cash machine and saying, 'Give me $200,'" said Bruce Thompson, pharmacy services director for Hennepin County Medical Center.

The machines dispense up to 100 of the most commonly prescribed drugs, including pain relievers, antibiotics, asthma inhalers, treatments for bee stings and remedies for the cold and flu.

Patients tap out a number from their doctor, answer a few questions and make a payment. A robot triple-checks the request against a barcode, sticks on an instruction label and drops the medicine out a chute.

"It's like using an ATM," said Powell, 57, of New Brighton, a repeat user of the InstyMeds dispenser. "It guides you through it, takes cash and debit cards, and has a brain. It knows I'm on Medicare and what I have to pay for my co-pay."

A phone attached to the machine is staffed 24 hours a day by insurance specialists in Eden Prairie who can answer questions, help patients work through co-pay issues or even direct them to the nearest pharmacy.

Dr. Jeff Vespa, assistant medical director of the emergency department at North Memorial, said about 18 percent of all prescriptions at the Robbinsdale hospital were dispensed by the machine last month. It is one of 48 machines across Minnesota.

"It's been a big advancement," Vespa said. "In the past, emergency departments haven't been very service-oriented. ... That's changing. We want to provide service and convenience along with medical care."

Some pharmacists have not been so quick to embrace the InstyMeds concept. They worry that patients need face-to-face counseling, especially those taking multiple drugs that might interact.

HCMC's Thompson said the machines are great for rural areas where patients might need to drive long distances to get to a pharmacy. But he said it can be cumbersome for some doctors to fill out the form InstyMeds uses for prescriptions. And if a patient happens to be trying to buy the medication at a time when the insurance company is doing a backup or offline, they could be stuck with paying for the entire cost up front.

Few competitors
Aside from companies that supply urgent care centers with small supplies of pre-labeled bottles of common prescriptions, InstyMeds have few competitors, said Dr. David Stern of Practice Velocity, a medical software company and network of 19 urgent care clinics in Chicago.

"It's a very good product, but it's not a cheap product," said Stern, who doesn't use InstyMeds in his clinics. "In the emergency room, it's a no-brainer. There are other options for urgent care centers that are less costly."

InstyMeds CEO Brad Schraut understands the concerns. There's a reason grocery chains and big box retailers such as Target and Wal-Mart want a piece of the $500 billion prescription business, he said. Industry figures show that the average patient spends $73 at the store beyond the price of their medications when they pick them up.

Schraut said InstyMeds intends to remain focused on the 15 percent of the prescription business that involves acute care medicine -- the drugs you want when you're in severe pain or that need to kick in right away to prevent infection.

The machines are compliant with privacy laws and have been cleared by the federal Drug Enforcement Agency as well as state regulators in every state in which InstyMeds does business.

While the industry reports 16 errors out of every 1,000 prescriptions, Schraut said InstyMeds machines have dispensed 1.4 million drugs "and not a wrong one yet." And if there's a recall, a click of the mouse instantly stops the drug from being dispensed.

Hospitals like it, Schraut said, because they can tailor the machines to drugs most needed in their facilities. InstyMeds automatically restocks inventory and handles all the billing.

Building the business
The company owns the machines, which cost about $55,000 each, and makes money on installation charges and a fee on each transaction.

The company was founded in 1999 by Ken Rosenblum, a former emergency room doctor who needed a prescription for his 5-year-old son's ear infection at 10 p.m. and couldn't find an open pharmacy.

After testing in a pediatric clinic in Minnetonka, the first machine hit the market in 2001 at Abbott Northwestern Hospital in Minneapolis.

Schraut believes federal health care reform efforts will work in InstyMeds' favor, because caregivers will be held accountable for lowering costs and keeping people healthy. If patients are more likely to take medicine because it's easy to pick up, they're less likely to show up in the emergency room with a more severe illness later, he reasoned.

But convenience can only go so far, Schraut said. "I don't ever want to see InstyMeds in gas stations or on street corners."