As cold chain volumes surge, driven by the rise of GLP-1s, biologics and other temperature-sensitive therapies, pharmacies are under pressure to evolve. Central fill models offer clear advantages in speed, efficiency and scalability, particularly for traditional prescription fulfillment. But when it comes to cold chain, centralization may not be the right answer and automation alone may not solve the real problem.
This requires a real discussion around when centralizing cold chain fulfillment makes sense and why pharmacies must look beyond throughput to address a common issue: pack-out and distribution.
Central fill: Powerful, but not always cold chain-ready
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Central fill models have transformed pharmacy operations. Automation technologies like robotic fulfillment and sortation, barcode scanning and conveyor routing have streamlined workflows and improved volume handling. However, cold chain fulfillment demands more than speed. It requires precision, compliance, reliability and space.
Low national drug codes (NDCs)/small formulary environments with high volumes per NDC present a unique opportunity for manual batch picking and filling strategies. In these cases, manual workflows can outperform traditional prescription automation in terms of work rate and flexibility. Automating picks often introduces high capital costs and requires significant operational footprints — investments that may not be justifiable, especially in cold chain operations where volumes typically remain below 5,000 prescriptions per shift, even in high-throughput settings.
This is where orchestration software becomes a critical enabler. By intelligently coordinating manual batch pick/fill workflows, it can drive higher efficiencies and throughput without the need for full automation. It allows cold operations to scale effectively while maintaining control over quality and compliance. As volumes rise, picking automation could prove to be beneficial, but only when combined with automated labeling and digital verification.
However, the real complexity emerges in the final stages: packing, labeling and shipping. These steps demand strict temperature regulation and introduce logistical challenges that go beyond fill rates. Consumables such as freezer packs, phase-change materials and insulated containers must be stored, conditioned and managed with precision. The footprint required to maintain these cooler consumables, along with staging space for pack-out, can rival or exceed that of the fill area itself.
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Without robust pack-out and distribution systems, central fill may not provide a viable solution for temperature-sensitive therapies. Success depends not only on efficient fill strategies but also on the ability to maintain product integrity through the last mile.
When cold chain centralization works
Centralizing cold chain fulfillment can be cost-effective with the right conditions:
1. Store proximity – Imagine a regional retail organization is considering a shift in its cold chain operations through centralizing fulfillment. The mindset behind this strategic shift is that it would streamline priority-based filling and barcode-validated sortation, enabling precise inventory management, reduced shrinkage and optimized working capital.
A key factor in its success is the retailer’s store footprint, which will significantly impact transit times and logistics. If its retail footprint is tightly clustered, central fill can work well. Shorter distances reduce transit time, lower the risk of temperature excursions and simplify logistics. Pharmacies with regional density can benefit from shared manifest systems and streamlined cold chain workflows.
2. Mailing medications – Home delivery enhances consistency, speed and reliability in pharmacy operations. It enables standardized packaging and temperature control, which improves the patient experience and ensures medication integrity. Additionally, last-mile automation and visibility — now expected by both patients and providers — are supported through integrated systems.
Beyond operational efficiency, carriers and couriers provide tracking and delivery service-level agreements (SLAs) that offer confidence in timely, secure delivery. These SLAs help ensure medications arrive at the correct destination on time, minimizing the risk of delays or expiry and meeting compliance and patient safety requirements.
3. Avoiding costly failures – According to IQVIA, the pharmaceutical industry loses approximately $35 billion annually due to temperature-controlled logistics failures. These include product spoilage, replacement costs and investigations. With cold chain drugs being up to 22 times more expensive than traditional medications, even minor errors can result in significant financial and reputational damage.
The real pain point: Pack-out and distribution
Many pharmacies need better systems for packaging and shipping. Cold chain medications require:
- Validated packaging workflows
- Real-time temperature tracking, forcing reduced time out of refrigeration through system driven directive
- Last-mile visibility
- Redundancy for weather and transit disruptions
Even advanced fulfillment systems often require manual intervention for cold chain pack-out. Without a strong distribution strategy, central fill can amplify pain points rather than reduce them.
What pharmacies should be asking
Before investing in central fill or automation for cold chain, pharmacies should ask:
- How do we currently handle cold chain pack-out?
- Are we maintaining temperature integrity through the last mile?
- Do we have visibility into shipment status and compliance?
- Can our system scale with growing cold chain volumes?
The answers to these questions will determine a successful cold chain operation.
Final thought: Centralization isn’t the first step — distribution is
Centralizing cold chain fulfillment is not a one-size-fits-all solution. Success factors include:
- Your stores are geographically concentrated.
- You plan to mail medications directly to patients.
- You have the infrastructure to manage temperature-sensitive logistics reliably.
But even then, success hinges on solving the pack-out and distribution challenge. Cold chain is a logistics problem — not just a throughput problem. Pharmacies must rethink their strategy, not just automate it.
As organizations evaluate whether central fill is the right move, they must determine what level of automation is most useful and how to do it right. This requires the understanding that one of the true complexities of cold chain fulfillment is pack-out and distribution.
Photo: metamorworks, Getty Images
Alecia Lashier, an engineer at heart, has dedicated more than two decades to breaking down problems, developing and integrating solutions of all sizes and complexities. As Chief Automation Officer at iA, Alecia collaborates closely with industry and academia leaders to advance technology solutions for the field of healthcare.
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