Health Care Management Science (2023) 26:344–362

https://doi.org/10.1007/s10729-023-09630-x

Priority-based replenishment policy for robotic dispensing

in central fill pharmacy systems: a simulation-based study
Nieqing Cao1 · Austin Marcus1 · Lubna Altarawneh1 · Soongeol Kwon2

Received: 11 February 2022 / Accepted: 5 January 2023 / Published online: 11 March 2023
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023

Abstract
In recent years, companies that operate pharmacy store chains have adopted centralized and automated fulfillment systems,
which are called Central Fill Pharmacy Systems (CFPS). The Robotic Dispensing System (RDS) plays a crucial role by
automatically storing, counting, and dispensing various medication pills to enable CFPS to fulfill high-volume prescriptions
safely and efficiently. Although the RDS is highly automated by robots and software, medication pills in the RDS should
still be replenished by operators in a timely manner to prevent the shortage of medication pills that causes huge delays in
prescription fulfillment. Because the complex dynamics of the CFPS and manned operations are closely associated with the
RDS replenishment process, there is a need for systematic approaches to developing a proper replenishment control policy.
This study proposes an improved priority-based replenishment policy, which is able to generate a real-time replenishment
sequence for the RDS. In particular, the policy is based on a novel criticality function calculating the refilling urgency
for a canister and corresponding dispenser, which takes the inventory level and consumption rates of medication pills into
account. A 3D discrete-event simulation is developed to emulate the RDS operations in the CFPS to evaluate the proposed
policy based on various measurements numerically. The numerical experiment shows that the proposed priority-based
replenishment policy can be easily implemented to enhance the RDS replenishment process by preventing over 90% of
machine inventory shortages and saving nearly 80% product fulfillment delays.

Keywords Central fill pharmacy system · Robotic dispensing system · Prescription fulfillment ·
Medication replenishment · Priority-based policy · 3D discrete-event simulation

Highlights • Proper replenishment strategy is required to prevent

delays in dispensing medications
• Robotic dispensing systems are introduced to fulfill
• Priority-based policy is proposed to determine the
high-volume prescriptions
replenishment sequence timely
• Criticality function is defined to calculate refilling
 Soongeol Kwon
sg.kwon@yonsei.ac.kr urgency for a canister
• Replenishment priority of dispenser is updated by the
Nieqing Cao criticality function value
ncao1@binghamton.edu

Austin Marcus
amarcus6@binghamton.edu 1 Introduction
Lubna Altarawneh
ltarawn1@binghamton.edu Mail-order pharmacy is used to fill and dispense licensed
prescription drugs and provide delivery service to patients.
1
Under the COVID-19 pandemic, mail-order pharmacy has
Department of Systems Science and Industrial Engineering,
Binghamton University, 4400 Vestal Parkway East,
been accelerated by large pharmacy companies due to
Binghamton, 13902, New York, USA contactless medication delivery to home, especially for
2 Department of Industrial Engineering, Yonsei
regular medication needs [1, 2]. In recent decades, Central
University, 50 Yonsei-ro, Seodaemun-gu, Fill Pharmacy System (CFPS) has become a popular
Seoul, 03722, Republic of Korea solution to process heavy volume prescription demand

13
Priority-based replenishment policy for robotic dispensing...
in large-scale mail-order pharmacy enterprises, such as
Amazon Pharmacy [3]. According to BBC Research, the
pharmacy automation market will grow from 5.1 billion
dollars in 2019 to 7.8 billion dollars by 2024 [4]. To satisfy
the needs of various medication types and the number of
items per order required by different customers as well as
the needs of significantly increased prescription demand,
the CFPS has been highly customized and automated.
Each CFPS, which is dynamic and flexibly designed,
is a pharmacy automation solution tailored to the local
pharmacy and puts the highest priority on the unique
personalized prescription filling to maintain patient safety
and satisfaction. Besides, pharmacy automation is a key
factor in fulfilling growing prescription demand while
decreasing prescription errors in the process of CFPS [5, 6].
In the CFPS, the Robotic Dispensing System (RDS)
is a critical automated facility that realizes pharmacy
automation and assures a high rate of fulfilling productivity
of a pharmacy [7]. Quickly developed in recent years, the
RDS is widely applied to storing, counting, dispensing,
and bottling countable pills by a robot arm, dispenser,
and canister. RDSs allow the CFPS to store and dispense
the most commonly prescribed medications, which ensures
convenience, accuracy, and agility in the dispensing process.
One type of RDS machine is shown in Fig. 1. Currently,
RDSs have become a general solution for millions of
medication errors occurring during the dispensing process
and filling over 90,000 patient prescriptions per day [8, 9].
To guarantee the high filling productivity and software
operation accuracy of RDSs, medication pills in the RDS
should be manually replenished in time to avoid medication
inventory shortage and system performance reduction. [10]
conclude that replenishment optimization of the automated
dispensing cabinet by clinical pharmacists can decrease the
number of stockouts and the number of dispenses from
a central pharmacy. Each RDS machine contains multiple
dispensers connected with one canister that contains
different medications to fill the dispenser. If the dispenser
0 Robot arm 0
Canister
Dispenser
0 0
0 0
Fig. 1 RDS machine schematic diagram
345
runs out of pills before the canister is reattached, “Rundry
Error”, which indicates that the dispenser cannot continue
filling due to the medication shortage, will be triggered
by operational delays; this contributes to most machine
errors. The rundry error can last hours before a canister is
replenished, which causes a decreased throughput of the
RDS and impacts on downstream machine performances.
Therefore, the RDS requires timely replenishment of
various medications by human operators to fully utilize the
CFPS.
To guarantee the high productivity of RDS, the proper
replenishment strategy is required to be uniquely designed
while considering prescription mixtures, human operation
complexity, and the CFPS dynamic, and there is a need
to develop an RDS replenishment policy designed for
inventory control to prevent rundry error. Although the
significance of replenishment process optimization has been
realized, there is still little research due to several challenges
in the analysis of the replenishment process. One challenge
is the complex decision-making for the replenishing priority
of canisters while considering the mixture of prescriptions.
For instance, which canister should be refilled first if
several canisters become empty? Another challenge is
that complex interactions between automated systems and
operators are difficult to be formally formulated. For
instance, the cart operator needs to shuttle between RDS
machines and replenishment stations as well as collaborate
with replenishment technicians.
To overcome these challenges and deal with the urgent
need to model the replenishment process, this paper
develops an improved priority-based replenishment policy
for RDSs. In order for the CFPS to prioritize the real-
time sequence of refilling canisters, the policy defines a
criticality function that returns the refilling urgency for
each canister and corresponding dispenser based on the
inventory level and pill consumption rates. In particular, a
3D discrete-event simulation model is developed to analyze
the system performance under the proposed strategy while
emulating the RDS human operations and reflecting real-
world practice and settings of the replenishment process in
the CFPS. A 3D simulator, which is able to support both
the logical and physical process designs, can help designers
verify the rationality and implementability of the system
design before the practice system installation [11]. Besides,
the 3D simulation software can help enterprises train new
operators and enable users to comprehend the CFPS as it’s
whole more thoroughly by providing a good visualization
for realistic feedback [12]. The simulation-based approach
has proved successful in addressing CFPS optimization
problems, which are hard to formulate mathematically and
obtain exact solutions due to the complex dynamic. It can
also represent, track, and analyze the detailed interactions
and sequence of replenishment events in the RDS, which
13
346 N. Cao et al.

can help to evaluate the practical replenishment strategy,
quantify the effects of different tailored strategies based on
multiple key performance indicators, and be extended to
meet more specific needs. Multiple performance metrics are
used to numerically analyze systems performance. Insights
for practitioners are provided to design and manage efficient
replenishment operations with limited resources to help
prevent medication shortages and reduce fulfillment delays.
The remainder of the paper is organized as follows:
The literature review that pertains to the robotic dispensing
and RDS replenishment process studies is presented in
Section 2. The detailed RDS replenishment process is
defined in Section 3. The priority-based replenishment
policy with a criticality function is described in Section 4.
Experiments and results are given in Section 5. Finally,
conclusions and suggestions of future works are offered in
Section 6.
2 Literature review
Given the importance of fulfilling increasing prescriptions
for daily demand and maintaining medication safe within
the pharmacy, robotic dispensing has become an active
research topic in the area of pharmacy automation. Many
studies now focus on RDS performance optimization.
Dispenser allocation optimization in the RDS unit has
been considered. [13] extract strong associations among the
purchased drugs through association rule mining, which
can help pharmacists properly allocate dispensers among
multiple robotic units and the efficient number of drugs
distributed inside the dispenser. [14] put forward an efficient
planogram strategy to determine the suitable number of
medications for each dispenser while balancing medication
associations, drug filling demand, and robot arm travel
distance. In addition, optimization of the filling time of
multi-item prescriptions is another aspect of the RDS
study. [15] identify that the disordered filling process
of RDS has become a bottleneck that limits system
productivity performance. The paper shows that setting
order priority policies and scheduling orders accordingly
can benefit system workload balancing and maximum RDS
utilization. Besides, as input for collation machines, the
RDS throughput can also make an impact on downstream
line system performance according to [16].
Due to the restriction of production by rundry errors, the
RDS replenishment process has been brought into focus in
recent years. [8] propose an RDS replenishment strategy
through a mixed integer programming method to help
determine the reorder point and backup canisters, which
can restrain inventory and operation costs while boosting
the efficiency of pharmacy inventory management. [17]
exploit a real-time optimization strategy using the receding
horizon control mechanism that has a fast response to
real-time dispenser replenishment and helps plan dynamic
inventory optimization. The replenishment operators have
been considered in RDS replenishment cost optimization
in [18]. The detailed system configurations and working
modes of the RDS are combined and determined through
mixed integer linear programming models. In literature
[19], the decision robustness that applies a receding
horizon control strategy with robust optimization has been
enhanced against the stochastic variables to avoid dispenser
inventory shortages and reduced throughput. [20] also
model the stochastic behavior of the replenishment process
by considering a probability distribution for lead time and
the uncertainty rate that dispensers count NDCs (National
Drug Code) and fill prescriptions using a continuous-time
Markov Chain. However, there exists minimal literature
that considers detailed human operations and develops a
priority-based inventory policy for RDS replenishment.
Table 1 summarizes the pharmacy replenishment-related
literature review.
Priority rule is one of the key factors that can influence
healthcare inventory problems and can be considered for
RDS replenishment. The priority rules, which are developed
and well-applied in pharmacy inventory management, can
be used to determine the criticality of inventory items and
resolve the order or replenishment processing sequence [15,
21]. The priority-based policy has proved its superiority in

Table 1 Summary of relevant studies on pharmacy replenishment process

Reference Objective Approach

Wang and Yoon [8]
Dauod et al. [17]
Serhan et al. [18]
Dauod et al. [19]
O’Connor et al. [20]
Minimize total costs for dispensing machine replenishment that Mixed integer programming
considers multiple factors
Minimize replenishment costs for real-time dispenser replen- Mixed integer programming
ishment with a receding horizon control mechanism
Minimize operational costs for determining optimal replenish- Mixed integer linear programming
ing settings of mail-order pharmacy automation systems
Propose a robust receding horizon control strategy for RDS Mixed integer programming
replenishment decisions
Minimize costs for determining optimal replenishing settings Markov Chain

13
Priority-based replenishment policy for robotic dispensing...
efficiency and low cost in the literature, which can alleviate
stock shortages the disordered replenishment process
causes. The replenishment decision can also become
robust by applying appropriate prioritization strategies
against demand uncertainty and over-forecast probability.
In addition, manual operations performed by technicians
and operators, which can be affected by undesired factors
and complex interactions between automated systems and
operators, are crucial to secure the practical and desired
throughput and are difficult to be formally formulated.
Therefore, there is an urgent need to adopt a systematic
approach that is tailored for RDSs with the priority-based
replenishment control policy, while considering the com-
plex dynamics of the CFPS and manual operations by
reflecting the real-world practice and ensuring desired per-
formance. This study proposes a criticality priority function
and exploits a discrete-event simulation model to emulate
and test it. The major originality and contributions that this
study provides from existing literature are as follows: (1)
a priority based replenishment strategy designed for RDSs
is proposed to help manage pharmacy inventory control;
(2) a tailored criticality priority function is developed to
eliminate medication shortages and fulfillment delays; (3)
detailed human operations for three types of operators are
modeled and analyzed to be close to real-world practice;
and (4) RDS configurations, i.e., canister size, the num-
ber of backup canisters, reorder points, and the number
of operators, are considered controllable variables in the
replenishment process.
3 RDS replenishment process analysis
One RDS unit contains a robot arm and several automated
dispensing cabinets controlled by a smart software system.
The robot arm is used to pick up, move, and drop off vials.
The slid dispensers in cabinets can be positioned as required
and also can be customized with different medications that
conform to individual pharmacy solutions and align with
the specific prescription volume. There is also a vertical gap
between lower-storied dispensers and upper shelves, which
Fig. 2 Dispenser and canister
schematic diagram
Canister
Dispenser
347
can dispose of different sizes of canisters for replenishment
that slides on the top of each dispenser. The dispenser and
canister schematic diagram is shown in Fig. 2.
Dispensers are used for storing, counting, and dispensing
tablet and capsule medications. Canisters are applied to
replenish connected dispensers. In the dispenser, if the
inventory level is less than a critical value tested by a sensor,
which can also be considered as a reorder point, the canister
will be triggered by the smart software system to release its
medications to the connected dispenser for refilling. After
all the available drugs are released, the canister’s status and
replenishing priority will be changed in the system and need
to be replenished by human operators. When the canister
needs to be replenished, it can be detached and reattached
for replenishment. Therefore, the predefined reorder point
of the dispenser, canister size, and replenishing priority
value are critical concerns in the canister replenishment
process.
The general replenishment process is considered in this
study, which means that there is an extra canister in the
workbenches for each dispenser, except the one connected
to the dispenser in the RDS machines. A replenishment
station is properly equipped near RDS machines for quick
response to the canister replenishment. There are three
types of operators, who are stock clerks, replenishment
technicians, and cart operators. Stock clerks work on
searching for medications used in the replenishment
process. Replenishment technicians go in to refill canisters
with drugs in the bottles found by stock clerks. Cart
operators engage in the transport of empty and refilled
canisters between RDS machines and the replenishment
station. In the replenishment process, when one canister
becomes empty, its information will be highlighted and
shown in the operating system interface for each operator.
The stock clerk processes the work sequentially according
to the canister priority value. Following the canister and
drug information indicated by the system, the stock clerk
should get the right medicine and the number of medicine
bottles required from the inventory racks. After receiving
the bottles from the clerk, the replenishment technician
can slide the extra corresponding canister to the docking
1500cc 500cc
chamber chamber
500cc
Canister chamber
800cc 800cc
chamber chamber
Dispenser
13
348
station on the workbench, refill it using the verified tablets
or capsules, and place it at the pickup window of the
replenishment station. When the refilled canister is ready
for picking on the operating system, the cart operator will
deliver it to RDS machines by a trolley cart, switch the
empty canister for the refilled one, and reattach it until it
confirms that the canister status comes online again. Priority
values are also used to determine which canister should be
reattached first if there are multiple refilled canisters waiting
for attachment. The detailed replenishment process is shown
in Fig. 3.
Rundry error is a key terminology that is used in
RDS replenishment process for dispenser unavailability
caused by the medication shortage. The refilled canister’s
return time determines the dispenser’s availability status.
If the dispenser can be replenished by the canister
before it becomes empty and stops filling orders, the
replenishment process will not make an impact on the auto
streamline productivity; otherwise, the dispenser cannot
complete the filling work caused by the rundry errors on
time and therefore causes the delay in customer order
delivery. With the rundry errors, the working time of RDS
machines will be prolonged under the same demands,
and filling interruptions may also easily lead to robot
failure. In addition, various rundry errors also reflect
the low work efficiency of replenishment operators and
required replenishing workflow optimization to mitigate
work accumulation. Apparently, delays from RDS machines
will have an influence on downstream performance, such
as vials’ collation time in the same order and packing
time. The relationship between dispenser inventory level,
Fig. 3 General replenishment process for dispensers. Canister A is first attached to the RDS dispenser and Canister B is the backup canister at the
replenishment station
13
N. Cao et al.
return time, and rundry error can be shown in Fig. 4. This
study focuses mainly on designing a replenishment policy
to prevent the rundry error that occurs when canister and
dispenser replenishment is not done properly.
4 Priority-based replenishment policy based
on criticality function
This section introduces the main contribution of our
study, a replenishment policy based on criticality function.
After introducing the basic concept of the priority-based
replenishment policy, Section 4.1 describes the criticality
function based on reasonable assumptions of CFPS goals.
Section 4.2 emphasizes the advantages of our designed
replenishment policy compared with the “Low-Medium-
High” policy, which is widely used in current CFPS.
A priority strategy specifies the sequence in which
canisters should be processed; in this case, canisters with
the highest priority values are operated first. When staff
in the replenishment process align their selection with the
priority order, the goals addressed by the priority (e.g.,
reduction in rundry errors) are more likely to be realized,
provided that the priority approach represents a sufficiently
accurate model of the system. Incorporating a priority
strategy is more challenging for a cart operator owing to
the extra complication of how to improve path efficiency.
In the current paradigm, the cart operator will leave the
replenishment station when no filled canisters are available,
will fill the cart in priority order, and will visit RDSs in
priority order regardless of distance. The priority order is
Priority-based replenishment policy for robotic dispensing... 349

Fig. 4 Rundry error impact

Dispenser inventory level

Dispenser inventory level

sketch map. The x-axis shows
time, and the y-axis shows the Waiting for refilling time
medication inventory level in
one dispenser, the dashed line
represents ROP (reorder point),
and the red line shows the ROP ROP
rundry error happening with no
medication in the dispenser Waiting for refilling time
Rundry duration
t1 t2(>t1)

utilized by each worker in the model in the same manner
whether the proposed priority strategy or current default
priority strategy is used.
4.1 Proposed replenishment policy based
on criticality function
One of the important purposes of the priority-based
replenishment process is to maintain a level of pill inventory
in RDS dispensers to prevent interruption in filling (the
occurrence of a rundry error). Therefore, our replenishment
system aims to avoid rundry errors in dispensers. Moreover,
if multiple dispensers have rundry errors, our system needs
to decide the order for which the corresponding canister
should be refilled first.
Main Idea: We first predict the time of rundry error
for each dispenser based on the future filling demand,
which is usually given in advance. We then determine the
optimal replenishment order of canisters directly based
on the predicted time of rundry error.
Equation 1 is the proposed priority-based replenishment
policy ρj with the criticality function f , representing the
priority that a canister, denoted as cj , needs to be refilled.
ρcj takes Ij and r̄j as input and outputs a priority value
ranging from 0 to 2, where Ij is the initially available
inventory in dispenser dj and its attached canister cj (in
units of either pills or volume), and r̄j is the inventory
consumption rate of dispenser dj and its attached canister
cj .
⎧ tj Ij
⎨0 ⇐⇒ not Empty(cj )
ρcj ≡ f (Ij , r̄j ) ⇐⇒ Empty(cj ) & not Rundry(dj )
⎩ f (I , r̄ ) + β ⇐⇒ Rundry(d )
j j j value in a range of continuous and numerical manner to
Where the function Empty means the canister cj is empty,
the function Rundry represents the dispenser dj has a rundry
error, β is a constant value.
In the equation, we model the priority value of refilling
canister cj in three cases. The first case is that when a
canister is not yet empty, the priority value of refilling
canister cj is 0, which indicates there is nothing to replenish.
The second case is that the priority value of canister cj
is f (Ij , r̄j ), when the canister is empty but the dispenser
still has enough pills to fill orders. The last one is that
when the dispenser has encountered a rundry error, the
priority of refilling the corresponding canister cj should be
higher than the other cases. This is because it is typically
important to address rundry canisters first to maintain
system performance. Here, a constant value β (i.e., β = 1
in our case) is added to distinguish dispensers with rundry
as a separate group while preserving relative replenishment
sequence information for the dispensers with rundry and
corresponding canisters by the criticality function. Figure 5a
shows a typical domain region of priority ρj . Volumetric
units, considering medication types and sizes, are used to
enable comparison across NDCs.
To develop the criticality function, specifically, the goal
is to obtain an estimated time when a dispenser will have a
rundry error, which is approximated by considering at what
time it will become completely empty (i.e., zero pills left).
This is modeled by
 tj
dIj
Ij − dt = 0, (2)
0 dt
where Ij is the initial available inventory in dispenser dj
and its attached canister cj , and tj is the estimated time
until rundry for dispenser j . One intuitive way to estimate
dI
this is to let dtj = r̄j , which is the inventory consumption
rate of dispenser dj and its attached canister cj . Because it
is desirable for dispensers with earlier rundry times to have
higher priority, Eq. 2 can be rearranged to give
1 r̄j
= , (3)
(1) which has the range (0, ∞). In order to make the priority
represent the refilling urgency of the canister, Eq. 3 is
1
plugged into 1+1/x producing, which produces Eq. 4 that
has the bounded range (0, 1]; this also has the benefit of
obviating special handling of the case where Ij = 0.
Ij −1 tj
f (tj ) = f (Ij , r̄j ) = (1 + ) = (1 + )−1 . (4)
m̄r̄j m̄
Here, f is the developed criticality function, and m̄ is
the typical makespan of the replenishment process. This
has the effect of tuning the sensitive region of f so that

13
350
differences in priority reflect the ratio between estimated
time to rundry and the time it typically takes to replenish
t
a canister (i.e., m̄j ). Figure 5 shows how m̄ scales f so
that a priority above 0.5 indicates the dispenser is expected
to rundry before the typical replenishment makespan. Note
that this scaling effect does not change the relative order
of the canisters. Lastly, f is utilized to define the final
proposed priority-based replenishment policy, which is used
in the simulation.
In the simulation, Ij is available by keeping a pill
count for every canister, which is already done as part of
the replenishment process, and r̄j is currently computed
as the cumulative inventory used by dispenser dj and
Fig. 5 Plots of the proposed priority function to demonstrate its
properties. Average replenishment makespan m̄ = 403 sec (derived
from simulation results)
13
N. Cao et al.
corresponding canister cj since the start of the simulation
run divided by the current simulation time. Note that the
estimation of the consumption rate utilizes only information
from the current shift/day. An estimation method that
produces a priority ordering closer to their true deadlines
may possibly be obtained by incorporating historical data
for each NDC/dispenser.
4.2 Proposed policy with criticality function vs.
“low-medium-high” policy
Theoretically, comparisons between the proposed and typi-
cal priority strategies are made in this section. The proposed
priority-based policy with criticality function developed in
Section 4.1 is intended to make an improvement over the
current priority strategy used in practicing CFPS. The cur-
rent typical priority strategy used in practice is defined by
Eq. 5: the “Low-Medium-High” policy.
⎧
⎨ Low ⇐⇒ not Empty(cj )
φj ≡ Medium ⇐⇒ Empty(cj ) & not Rundry(dj ) (5)
⎩
High ⇐⇒ Rundry(dj )
Under the same priority level, each empty canister’s refilling
sequence is determined by the moment that the canister
becomes empty. The fundamental issue with this strategy
is that the priority level cannot reflect the refilling urgency
and the system impact caused by potential rundry errors.
Equation 1 addresses this issue by essentially using the more
appropriate attribute of estimated rundry time to break ties
between the priority of canisters, rather than using the time
at which the canister becomes empty.
Table 2 provides an example situation with realistic
values. In this example, there are two canisters, A and
B, which empty at time 10 and 11 seconds, respectively.
They have the specified average consumption rates (r̄j )
and current inventory levels (Ij ). From this, the estimated
time to rundry (tj ) is computed via rearranging Eq. 3.
Then the priority level under Eq. 1 (ρj ) and Eq. 5 (φj )
are computed. Consider a replenishment technician who
must make a choice between A and B. The “Low-Medium-
High” strategy would direct him or her to select canister
A because both are Medium priority and A became empty
just before B. The issue with this approach is that B has an
earlier estimated rundry time because of less inventory level.
Equation 1 overcomes this issue: ρj is greater for B than
for A, precisely because it increases with t1j , and thus B is
selected first by the technician, which reduces the likelihood
of a rundry error (Tables 3 and 4).
Priority-based replenishment policy for robotic dispensing...
Table 2 Example of a realistic decision point during the replenishment process
Canister Time Emptied Avg. consumption rate r̄j
A 10 sec 0.026 cc/sec
B 11 sec 0.026 cc/sec
5 Numerical experiments
5.1 Simulation model description
A large system that can handle tens of thousands of
prescriptions is developed to better observe the impact
of replenishment and rundry errors. There are 16 RDS
machines arranged in two rows and connected with
conveyors that transport filled vials. If only one vial is
required by a prescription, which is a single-bottle order,
the vial will be sent to packing stations directly for packing;
otherwise, this is a multi-bottle order, and the vial will be
transferred to collation stations first for collating vials in
the same order number and then sent to packing stations.
A replenishment station is set near the RDS machines for
convenient replenishment. The system layout is shown in
Fig. 6.
Due to the reason that the travel distance can have
a significant impact on the replenishing time and cart
Fig. 6 Layout information in the replenishment simulation model
351
Inventory level Ij Estimated rundry time tj ρj φj
13.0 cc 500 sec 0.45 Medium
7.8 cc 300 sec 0.57 Medium
operators’ decision, especially in a large system, the
physical distances between each RDS unit and distances
between the replenishment station and each RDS unit are
considered. The consideration of distances introduces a
trade-off problem between minimizing the distance the
cart operator travels and reattaching canisters in priority
order. Furthermore, rundry errors may be prevented in some
cases by deviating from priority order and minimizing total
distance traveled, or in other cases the inverse may be true.
This study did not attempt to resolve this trade-off, and
therefore programmed cart operators to reattach canisters
only in priority order; it does not consider the minimal
length path in which to visit them, although the travel time
between stations is accounted for in the simulation. The
shortest-path distances between each pair of stations were
computed, stored in a distance matrix (see Table 5 in the
appendix) according to the locations of labeled machines in
Fig. 6, and accessed by the simulation model to compute
the simulated delay in cart operator procedures, which
13
352
represents their travel time. After each reattach, the cart
operator determines the next destination and references the
distance matrix accordingly.
Configurable settings in the replenishment model are
determined below according to the whole CFP scale, the
number of RDS units, and system prescription demand.
• Staff arrangement: 1 cart operator, 3 stock clerks, and 3
replenishment technicians;
• Cart setting: total 1 cart that contains no more than 24
canisters;
• Canister setting: 75% 2000 cc canisters (including a
1500 cc chamber and 500 cc chamber) and 25% 500 cc
canisters (including a 500 cc chamber);
• Dispenser setting: 800 cc dispenser;
• When releasing pills from canister to dispenser, the
door between canister and dispenser will remain open
until all the pills drop into the dispenser, which
can continuously dispense medication with the door
opening.
• ROP in dispenser: When the dispenser inventory
becomes or is lower than 100 cc, the system will trigger
the connected canister to release its available chamber;
• Backup canister setting: Each canister has one other
backup canister at the replenishment station;
• Priority strategy: Current three-stage priority strategy
determined by rundry errors and timestamps.
In general, for the purpose of system layout design, prob-
ability distributions well-reflecting the targeted processing
time with less variability are supposed to be considered
for the simulation model to reflect system operations with
stabilized workstations and skilled operators. Because cen-
tral fill pharmacy systems are highly automated with robots
and machines, operations can be well-controlled to result
in targeted performance. Moreover, in the case of manual
processes supposed to be done by the operators, operations
would be simplified, standardized, and done repeatedly, and
the process can be well-controlled to result in performance
within the targeted range. Therefore, in our study, triangu-
lar distribution is adopted to simulate the processing times
of various processes as shown in Table 6. Note that the tri-
angular distribution can be defined in terms of mode and
lower/upper limit, which can be considered as the targeted
processing time and the range for variability, respectively.
Additional system assumptions and restrictions considered
for the simulation model are listed below.
• Each RDS machine can hold up to 80 different
medications.
• The RDS machine cannot deal with and needs to delay
the prescription if the dispenser has a rundry error until
13
N. Cao et al.
the dispenser has been replenished and comes online
again.
• Each cart operator can handle only one specific cart.
• The cart operator returns the refilled canister first and
then retrieves the empty canister in the RDS machine.
• Whenever the cart operator is available and sees refilled
canisters at the replenishment pickup window, he or she
will react.
• Reattachment sequence also follows the priority strat-
egy.
• The walking speed of cart operators is 55 inches/sec.
A specialized 3D simulation solution approach is
developed to reflect the dynamic replenishment model for
RDS units. Emulate3D simulation solver [22], an industry-
leading dynamic digital software designed for virtual
commissioning and throughput simulation, is utilized
to keep tracking the dynamic replenishing operations
and recording the movement data and status changes.
The implementation of the replenishment model and
proposed priority-based replenishment policy are described
in Algorithm 1 in the appendix. There are four main entities
in this aspect of the simulation: Auto-Fill stations, Stock
Clerks, Replenishment Technicians, and Cart Operators.
QuickLogic tables are used to track the necessary simulation
state relevant to replenishment: each canister’s inventory
level; its consumption rate and priority; the canister’s
position in the replenishment process; and transactional
demand data. When an entity completes a process on a
canister, it updates a shared data structure to which the
other entities respond as appropriate. First, the Auto-Fill
stations read the transactional demand data and begin filling
vials accordingly while tracking pill levels in each canister.
When a canister becomes empty, the Stock Clerks will see
the corresponding change in the shared data structure and
will begin delivering the appropriate bottles, which updates
the shared data structure accordingly. The Replenishment
Technician and Cart Operator react to changes in the shared
data structure in a similar manner. Once the Cart Operator
has switched and attached the refilled canister, the Auto-
Fill station will recognize the updated inventory level and, if
there had been a rundry error, can then begin to dispense the
blocked item. Each entity incorporates the priority function
into its routine when selecting a canister to be worked on
next, as can be seen in Algorithm 1. Note that the priority
for a canister Cx is updated exactly when Cx has been used
to fill an item x. This means that the priority for a canister
could change mid-replenishment, which could affect the
selection of entities further down the pipeline, which allows
for quicker adaptation to demand. More details of the
simulation model can be found in Table 7 in the appendix.
Priority-based replenishment policy for robotic dispensing...
5.2 Simulation model verification and validation
Model verification is essential to ensure that the simulation
model operates as intended. For model verification, the
assumptions and processing time utilized in the simulation
model are defined in accordance with the designer-
provided design workbook, which was created by CFPS
designers in accordance with the machines’ specifications
and observations from actual CFPSs. According to the
3D CAD layout design drawing, the simulation facility’s
location and conveyor system elevation are designed. To
verify that the model is functioning as intended, activity logs
are kept for each entity (e.g., operator, dispenser, canister,
and product), including route tracking and operation time
recording. For instance, we design simple demand data
to verify whether a specific RDS machine works as we
designed. Figure 7 shows how the RDS machine operates
with simply designed demand data. The first vial is to be
filled as scheduled. For the second vial, although the order
arrival time, i.e., scheduled time, is earlier, the start filling
time of this vial still begins after the previous vial finishing
filling due to the robot arm being busy filling the first item.
For the fourth vial, it begins to start filling when the order
arrives. There exists a time gap between the third and fourth
vial because of the designed unevenly distributed demand
data; the RDS robot arm would be in idle status during the
gap time. From the sample results in the figure, we can
conclude that the model works well following the rules we
designed.
Model validation is important for evaluating if the
simulation model accurately represents the real system. Due
to the fact that the CFPS is highly tailored based on local
demand and size, and the CFPS simulation model is usually
Fig. 7 Verification study of
filling time in one RDS machine
353
developed to test system performance before physical
facilities building, it is difficult to obtain local real demand
data in advance. For model validation, therefore, the
replenishment simulation model and outcomes are validated
by professionals with experience operating physical CFPSs.
5.3 Case study
In this research, a practical pharmacy-based prescription
database is employed in the simulation model, which
can reflect the actual pharmacy situation where rundry
errors occur frequently. The database consists of 36,925
transactions of single and multiple prescription orders
that needed to be filled with medications. There are
20,735 preparatory vials for single-item orders and 16,190
preparatory vials for multiple-item orders. The demand data
is uniformly distributed during a 7.5-hour shift from 16
RDS machines. One thousand two hundred eighty types of
medications, which are tagged as a unique product NDC for
each medication to indicate the drugs with specific dosage
strengths and manufacturers, are uniformly assigned to the
demand order. Table 8 in the appendix shows an example
of the transactional demand data of dispensed drugs. Each
event log represents the specific information for one vial,
which includes the knowledge of the drug, the assigned
filling RDS machine, order type, processing time, canister
or dispenser information, and the number of pills required
to fill the vial.
Due to the conflict between volume and quantity used
in the inventory capacities of canisters or dispensers and
the dispensing process, the basic unit “Quantity/100cc” is
utilized to transform volume and quantity. The distributions
of quantity/100cc and the number of drugs needed for one
13
354
Fig. 8 Number trajectory of dispensers suffered from rundry error and
number trajectory of items waited for fixing rundry error in Case 1
and Case 2. The x-axis shows the shift time, and the y-axis shows the
number of dispensers or items
prescription in one bottle are presented in Tables 9 and 10 in
the appendix, which are summarized from a real pharmacy
transaction database from a central fill pharmacy.
In running simulations, the objectives of this study are
to observe how the unseasonal and disordered priority-
based replenishment policy impacts a set of performance
measures and how to eliminate the rundry errors during the
replenishing process. There are two groups of performance
measurements, which are RDS performance evaluation
and downstream performance evaluation, to assess the
CFP productivity and working efficiency. The key metric
that measures the performance of the RDS is the total
number of rundry errors that happen during the work shift.
Comparisons to the number of rundry errors can reflect
whether there exist operational delay and disorder. Collation
delay, which is the time between the first and last item
13
N. Cao et al.
in a group are collated at collation stations, is used to
evaluate the downstream collating performance for multi-
item prescriptions. The value of collation delay reflects the
impact on downstream workstations, which can be enlarged
by the rundry errors. The maximum collation delay is
considered.
Two cases are considered in this research.
• Case 1: Replenishment process with default “Low-
Medium-High” priority strategy. This model is devel-
oped to reveal how the replenishing staff works between
RDS units and replenishment stations as well as how
the rundry errors impact the RDS working throughput.
• Case 2: Replenishment process with the proposed
priority-based policy that is determined by multiple
influence factors. The model is employed to show
how the proposed priority model improves the system
performance compared with Case 1.
5.3.1 Rundry error analysis
There is a total of 134 rundry errors that occurred in the Case
1 model, which means that the replenishment process with
the current priority strategy cannot quickly respond to the
1280-canister inventory holding under current configurable
settings in the system. There is no need to change current
configurations; Case 2 model can achieve only 11 rundry
errors by reasonably assigning the waiting sequence of
the empty canisters, which proves the efficiency of the
proposed priority strategy for refilling consecutiveness.
Figure 8 reflects the trajectory changes of the real-time
number of unavailable dispensers with filling interruption
due to rundry errors as well as the real-time number of
blocked items waiting for fixing rundry errors. In both cases,
the number of blocked items is greater than or equal to
the number of unavailable dispensers; this indicates that
one rundry error can cause multiple items to wait for the
filling process. The existing rundry errors also indicate the
heavy replenishing workload under current configurable
settings in the CFPS. Overtime completion after the shift
hour ends, in which there are no additional prescription
demand orders, is still needed. In Case 1, the rundry errors
easily happen when there are over 100 empty canisters
waiting in the RDS machines during the peak working
period. The value peaks at the end of the shift due to the
continuously increased empty canister caused by operation
delays. Without additional prescription demand after the
7.5-hour shift, the rundry errors and blocked items can
be fixed in an hour. In Case 2, most dispensers can keep
working on filling processes with only several rundry errors
even if there exist over 400 empty canisters that need
Priority-based replenishment policy for robotic dispensing... 355

Fig. 9 Inventory trajectory of the top two highest-frequency rundry drug inventory of the specific NDC attached to the RDS unit. The
NDCs. The y-axis indicates the total available dispensing inventory lower dash line manifests the moment that the connected canister emp-
level, which includes the inventory in the dispenser and connected can- ties its final chamber, and operators are notified of the empty status of
ister. The upper dash line shows the maximum capacity of the total the canister

refilling, which means that the proposed priority strategy

can enhance the rundry error tolerance in the RDS and
improve the robustness of the system. Rundry errors can be
delayed up to four hours compared with Case 1 and numbers
can be drastically reduced as replenishment operators can
identify impending problem dispensers and refill in a timely
manner.
Figure 9 shows the available dispensing inventory
trajectories of the top two highest-frequency rundry NDCs
as an example to show the rundry error effect. For the first
example, NDC in Fig. 9a and b, the inventory consumption
patterns are similar in both cases in the first two working
hours due to a sufficient number of drugs in the canisters.
With the continuous increment of dispensers and canisters
waiting for replenishment, the canister of the NDC in
Case 1 cannot be refilled by operators on time because it
needs to wait in the queue to follow the timestamp rules
in the “Low-Medium-High” priority strategy. However, the
canister in Case 2 can be responded to immediately when its
inventory is lower than the reorder point. This is because the
canister can jump the queue by adjusting a higher priority Fig. 10 Collation delay in different cases

13
356
Fig. 11 Examples of item
processing time from filling to
collating in two cases. Figures
(a) and (b) are under a two-item
prescription order. Figures (c)
and (d) are under a three-item
prescription order
value based on the consumption estimation from previous
consumption patterns. As a result, the total replenishment
work of the canister in Case 2 can be completed earlier
several hours than in Case 1 and no rundry error happens.
For the second example NDC in Fig. 9c and d, the canister
can be replenished quickly at the first two times in both
cases due to adequate staff. Five rundry errors appear in
Case 1 during the peak workload period and the reattached
canister would release its chamber immediately and become
empty again. In Case 2, the anticipation of rundry time helps
eliminate rundry errors even in a highly utilized canister.
For both NDCs with high-frequency rundry, the smaller size
of the canister and larger pill size are also the reason that
causes rundry to happen.
5.3.2 Overall system performance analysis
The different filling sequences will also have an influence
on the collation delay in the collation station. Figure 10
shows how the maximum collation delay change under
two cases. From the results, we can find that the collation
time to finish collating one order has been significantly
Table 3 Measurement
comparisons in Case 1 and Evaluation indicator
Case 2 under 95% confidence
interval Num. of rundry errors
Num. of uncompleted items during shift
Makespan of RDS machines
Avg. collation delay
Max. collation delay
13
N. Cao et al.
extended in Case 1 model. The prolonged collation delay
indicates that the resources in collation stations need to
be occupied longer by one order, which is contrary to the
effective utilization of the collation stations. However, by
reorganizing the canister refilling process in Case 2, the
sequence of filling vials in the RDS units has also been
rearranged as a consequence, and the collation stations can
be exploited more smoothly and adequately. With only a few
rundry errors, the results of the proposed priority strategy
can be close to the ideal case that has no inventory shortage
and replenishment.
Figure 11 exploits two examples to reflect the impact of
collation delay in different cases. The length of the blue
bars indicates the processing time of one item from the
filling start point to collating start point, while the length
of the red bars represents the collation delay of the multi-
item order. In the two-item prescription example, the time
required to complete the collation of Case 1 is over 40
times that of Case 2. This is caused by the filling delay
in the RDS machines that the second item cannot start
processing immediately due to the suspended dispenser
with medication shortage when the order arrives. The time
Case 1 Case 2
134.14 ± 0.28 11.43 ± 0.40
29.43 ± 1.20 1.00 ± 0.86
7.97 ± 0.02 h 7.56 ± 0.00 h
1.58 ± 0.02 min 1.49 ± 0.02 min
58.64 ± 0.26 min 8.55 ± 0.19 min
Priority-based replenishment policy for robotic dispensing...
Table 4 System performance comparisons under different distributions of operator processing time
Evaluation indicator Exponential distribution
Case 1
Num. of rundry errors 127.67 ± 10.02
Num. of uncompleted items during shift 28.83 ± 11.42
Makespan of RDS machines 8.07 ± 0.10 h
Avg. collation delay 1.59 ± 0.03 min
Max. collation delay 53.59 ± 13.77 min
between two blue bars in Case 1 represents the blank
time quantum of the occupied tube in the collation station
without any operations, which indicates inefficient tube
utilization with workload reduction and liquidity dulling.
In the three-item prescription example, the collation delay
is still prolonged due to the filling dispenser interruption,
which may happen in previous orders even though there is
no disruption during the RDS filling in this order.
Table 3 summarizes the measurement comparisons
between Case 1 and Case 2. In Case 1, with the
increment of rundry errors, RDS units cannot complete
the prescription demands as specified during the 7.5-hour
shift and need an extra half an hour to finish filling
the same demand that there is much ineffective time at
the end of the shift. One thing that should be noted is
that although the gap between average collation times
in the two cases has not significantly widened, some
individual samples with enlarged collation delays can
cause a huge problem of system performance degradation.
The impact of priority rules on system performance
is shown more distinctly in Case 2. Only 11 rundry
errors happen that have not had a huge influence on
the RDS and downstream performance in the complex
CFPS operations. This means that the pre-estimated rundry
time acts more on the filling sequence optimization
compared with the post-time after the change of canister
status.
5.3.3 Uncertainty analysis
Due to the fact that variances and unanticipated events may
exist among operators with varying individual working per-
formances, the triangular distribution cannot fully reflect
the occurrences in actuality when applied to operator pro-
cessing time. Consequently, the research additionally inves-
tigates the robustness of the model by applying exponential
and normal distributions to the processing time of operators
with potentially unstable performance while working.
In comparison to Table 3’s results, Table 4 reveals
that there are substantial performance variations under
357
Normal distribution
Case 2 Case 1 Case 2
13.43 ± 4.50 134.43 ± 0.73 11.14 ± 0.90
1.29 ± 1.26 31.43 ± 2.49 1.00 ± 0.43
7.57 ± 0.02 h 7.99 ± 0.02 h 7.56 ± 0.00 h
1.49 ± 0.02 min 1.59 ± 0.01 min 1.49 ± 0.01 min
9.46 ± 0.91 min 59.96 ± 2.48 min 8.43 ± 0.16 min
the 95% confidence interval by using the exponential
distribution, which represents the unstable output generated
by operators. With a large variance in the working rate
of operators, for instance, more than 40 vials may be
unable to be filled within a shift hour due to more rundry
errors, necessitating more time to finish filling tasks. One
collation tube may be occupied for more than an hour,
which would have a severe impact on production line
mobility and consume collation resources. The normal
distribution can also result in a somewhat wide variation
for the rundry times, number of uncompleted products,
and the collation delay time when compared to triangular
distribution.
Results from Table 4 suggest that the proposed replenish-
ment method illustrated by Case 2 outperforms the present
default replenishment method illustrated by Case 1 even
when the replenishment operators cause considerable vari-
ances. In addition, results under Case 2 demonstrate that
fluctuations in system performance can also be controlled
within a small acceptable range, even with uncertainties
happening from the staff side. With the proposed priority
method, over 90% of rundry errors can be avoidable. Near
80 % fulfillment delay time can be saved to complete all
infilling works in 10 minutes after shift hours. Moreover,
downstream stations’ resources, e.g., collation stations, can
be utilized in an efficient way.
6 Conclusion
This research proposes a priority-based replenishment
control policy to optimize the canister refilling sequence in
the RDS machines to minimize medication shortages and
fulfillment delays that happen during the filling process
in the CFPS without changing any configurable settings.
The proposed strategy estimates the time that a dispenser
becomes rundry by multiple factors, which involve the
average consumption rates and current inventory levels,
instead of considering only the time that the canister status
changes. In addition, the complex manual replenishment
13
358 N. Cao et al.

operations for each type of operator and the dynamics
of the CFPS are developed by a discrete-event simulation
model. Three types of operators are under their own logic
procedure so that the model can achieve and control the
dynamic and complex operations close to reality. A large-
scale pharmacy-based system has been developed with
real machine configurations that consider the mixture of
prescriptions. The simulated system has been evaluated
from RDS and downstream performance aspects. Case
studies with and without the priority-based replenishment
policy are compared with the performance indicators.
Compared to the Case 1 model with the default “Low-
Medium-High” priority strategy, the proposed priority
strategy in Case 2 model is a strong performer in eliminating
the rundry errors during the refilling process. The proposed
system can perform close to the reference model without
any inventory shortage and replenishment, which has
proven that the consumption rate and current inventory
level play an important role in optimizing the refilling
sequence.
One limitation is that the current simulation model
in the paper cannot provide the optimal settings, like
the optimal number of canisters and operators. The
simulation-based optimization framework can be expanded
to determine the proper level of parameters and configurable
parameters to optimize the system performance. Besides,
the entire CFPS performance has not been checked with
the change of replenishment policy. In addition, the
practical happenings, such as the cart operator routing
way, unforeseen downtime of RDS, and the scheduled
maintenance, have not been considered in the paper.
Future work of this research will focus on the potential
ways to improve the system’s performance. With current
resources and configurations, the priority strategy and
different operation strategies can be optimized further
regarding the entire CFPS performance improvement. The
estimated future demand with statistical information can
be considered as one of the indicators in the priority
strategy. Besides, the cart operator’s travel distance and
pick-up way can be optimized as a strategy. The resources
and configurable settings can also be optimized to give
better reasonable suggestions while considering costs.
Additionally, more NDC information can be gathered from
actual prescriptions in the CFPS to generate the demand
distribution.
Appendix

Table 5 Distance matrix for travel time computations of the cart operator (unit: inch)

Source 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 R1

1 − 150 300 450 1057 1207 1357 1507 1458 1308 1158 1008 397 247 97 53 982
2 − − 150 300 907 1057 1207 1357 1308 1158 1008 858 247 97 53 203 832
3 − − − 150 757 907 1057 1207 1158 1008 858 708 97 53 203 353 682
4 − − − − 607 757 907 1057 1008 858 708 558 53 203 353 503 532
5 − − − − − 150 300 450 1449 1299 1149 999 660 810 960 1110 973
6 − − − − − − 150 300 1599 1449 1299 1149 810 960 1110 1260 1123
7 − − − − − − − 150 1749 1599 1449 1299 960 110 1260 1410 1273
8 − − − − − − − − 1899 1749 1599 1449 1110 1260 1410 1560 1423
9 − − − − − − − − − 150 300 450 1061 1211 1361 1511 654
10 − − − − − − − − − − 150 300 911 1061 1211 1361 504
11 − − − − − − − − − − − 150 761 911 1061 1211 354
12 − − − − − − − − − − − − 611 761 911 1061 204
13 − − − − − − − − − − − − − 150 300 450 585
14 − − − − − − − − − − − − − − 150 300 735
15 − − − − − − − − − − − − − − − 150 885
16 − − − − − − − − − − − − − − − − 1035
R1 − − − − − − − − − − − − − − − − −

13
Priority-based replenishment policy for robotic dispensing... 359

Algorithm 1 Pseudocodes for the simulation model. Each procedure runs in parallel with the specified number of instances of each one. The three
replenishment worker procedures respond to the changes in the shared data structures, Cn and f illQueue.

13
360 N. Cao et al.

Table 6 Replenishment simulation model processing time assumptions

Machine & Staff Task Processing Time

RDS unit Fill vials Tri[10.5,11.1,11.7] sec/item

Collation unit Pick up input vials Tri[2.5,2.6,2.7] sec/item
Release collated orders Tri[7.5,7.9,8.3] sec/tote
Conveyor speed Transport vials 65 ft/min
Replenishment operator Replenish canisters Tri[228,240,252] sec/canister
Stock clerk Stock canisters Tri[15.5,16.3,17.1] sec/canister
Stock inventory Tri[13.9,14.6,15.3] sec/bottle
Cart Operator Unload carts Tri[7.2,7.6,8.0] sec/canister
Load carts Tri[8.5,8.9,9.3] sec/canister
Detach/Attach canisters Tri[5.7,6.0,6.3] sec/canister

Table 7 Elements of simulation model based on the checklist proposed by [23]

Checklist item Content

Purpose of the model Analyze the system performance under different priority-based replenishment strategies.
Model outputs RDS performance evaluation: Total number of rundry errors Total number of uncompleted items during shift
Trajectory of the number of dispensers suffered from rundry error Trajectory of number of blocked items
waited for fixing rundry error Inventory trajectory for each dispenser and canister Makespan of RDS machines
Downstream performance evaluation: Avg. collation delay, Max. collation delay
Experimentation aims Emulating the RDS human operations and reflecting real-world dynamic practice and settings of
replenishment process in the CFPS.
Base model overview diagram Shown in Fig. 6.
Base model logic Shown in Section 5.1 and Fig. 6.
Algorithm Shown in Algorithm 1.
Components Entities: Shown in Section 5.1. Activities: Shown in Section 5.1. Resources: 3D CAD file layout, design
workbook data used for parameter settings, and technical book used for configuration settings are provided by
the designer of CFPS. Queues: Vial filling queue: First in First Out Canister refilling queue: Priority strategy
is shown in Section 4. Staff working sequence: The next staff will only work if previous staff is busy. Entry
/ Exit points: Entities’ entry points are related to the order arrival time and queue. Entities’ exit points are
dependent on the activities that are all finished.
Data sources Amount of demand data are provided by the designer of CFPS, which is related to the CFPS scale and
historical data from other CFPSs.
Input parameters Shown in Table 6.
Pre-processing Demand data is uniformly distributed during a 7.5-hour shift from 16 RDS machines.
Assumptions Shown in Section 5.1.
Initialisation Warm-up period is 10 min.
Run length The model has a run length of 24 hours including the 7.5-hour shift time and remaining time for finishing the
filling and refilling work.
Estimation approach All point estimates are based on the average of 50 replications of a model run.
Software or programming language Emulate3D simulation solver is used for building the simulation model by enterprises license. The software
provides QuickLogic simulation language to help program C languages.
Model execution Model run time is 5 hours per replication.
System specification The model is run on Dell XPS 8940, with a 3.6Ghz Intel Core i7 processor and 32 GB of memory under
Windows 10 Pro.
Computer model sharing statement The simulation model is built by the enterprise version of Emulator3D and cannot be shared due to
confidential reasons.

13
Priority-based replenishment policy for robotic dispensing... 361

Table 8 Example of the transaction database

GroupId UniqueId NDC FillingMachine NumItemsPerOrder OrderType ArrivalTime CansName NumPills

13637 13737 71854968702 15 1 Single-Bottle 7:00:01 AM Cans1158 90

12640 12740 52257012162 2 1 Single-Bottle 7:00:02 AM Cans92 90
14379 14479 78947621005 1 1 Single-Bottle 7:00:02 AM Cans47 60
17896 17996 50587961728 5 1 Single-Bottle 7:00:03 AM Cans386 30
6923 7023 33368199505 5 1 Single-Bottle 7:00:04 AM Cans345 30
25089 29636 06787139284 6 4 Bottle/Collation 9:37:17 AM Cans429 89
25089 29637 93758326065 7 4 Bottle/Collation 9:37:17 AM Cans535 30
25089 29638 89491922927 11 4 Bottle/Collation 9:37:17 AM Cans806 30
25089 29639 62731662932 13 4 Bottle/Collation 9:37:17 AM Cans975 90

Table 9 Qty./100cc distribution forum, vol 1. American Medical Association, pp e200,038–

e200,038
Qty / 100cc % 4. Research BCC (2019) Pharmacy automation: Technologies and
global markets https://www.bccresearch.com/
50 3.8 5. Gebhart F (2019) The future of pharmacy automation. Drug Top
100 7.0 163(7):18–22
175 16.2 6. Sng Y, Ong CK, Lai YF (2019) Approaches to outpatient
pharmacy automation: a systematic review. Eur J Hosp Pharm
250 16.8 26(3):157–162
400 23.5 7. Rodriguez-Gonzalez CG, Herranz-Alonso A, Escudero-Vilaplana
[100, 300] 27.0 V, Ais-Larisgoitia MA, Iglesias-Peinado I, Sanjurjo-Saez M
(2019) Robotic dispensing improves patient safety, inventory
[300, 475] 5.7
management, and staff satisfaction in an outpatient hospital
pharmacy. J Eval Clin Pract 25(1):28–35
8. Wang H, Yoon SW (2016) Drug dispenser replenishment
Table 10 No. of pills per item distribution optimization via mixed integer programming in central fill
pharmacy systems. In: Industrial and systems engineering research
Pill counts / item % conference
9. Dauod H, Li D, Yoon SW, Srihari K (2018) Multi-objective
30 70% optimization of the order scheduling problem in mail-order
60 10% pharmacy automation systems. Int J Adv Manuf Technol
99(1):73–83
90 15% 10. Lupi KE, Day KM, Gilmore JF, DeGrado JR (2020) Evaluation
Other [15, 180] 5% of a clinical pharmacist-led automated dispensing cabinet
stewardship program at a tertiary academic medical center. J
Pharm Pract 33(5):576–579
11. Rossmann J, Schluse M, Schlette C, Waspe R (2012) Control
Acknowledgements This study was supported by the Watson Institute by 3d simulation–a new erobotics approach to control design in
of Systems Excellence (WISE) at Binghamton University. automation. In: International conference on intelligent robotics
and applications, Springer, pp 186–197
12. Yang K, Jie J (2011) The designing of training simulation system
Declarations based on unity 3d. In: 2011 Fourth international conference on
intelligent computation technology and automation, vol 1. IEEE,
Conflict of Interests The authors declare that there is no conflict of pp 976–978
financial interest. 13. Khader N, Lashier A, Yoon SW (2016) Pharmacy robotic
dispensing and planogram analysis using association rule mining
with prescription data. Expert Syst Appl 57:296–310
14. Wang H, Dauod H, Khader N, Yoon SW, Srihari K (2018) Multi-
References objective parallel robotic dispensing planogram optimisation
using association rule mining and evolutionary algorithms. Int J
1. Alexander GC, Qato DM (2020) Ensuring access to medications Comput Integr Manuf 31(8):799–814
in the us during the covid-19 pandemic. Jama 324(1):31–32 15. Wang H, Yoon SW (2014) Evaluation and optimization of
2. Herzik KA, Bethishou L (2021) The impact of covid-19 on automatic drug dispensing/filling system. In: Proceedings of the
pharmacy transitions of care services. Res Soc Adm Pharm 3rd annual world conference of the society for industrial and
17(1):1908–1912 systems engineering
3. Shaya FT, Eddington ND (2020) Disruptive innovation in 16. Li Y, Zhang Q, Yoon SW (2019) Discrete event simulation-based
pharmacy: Lessons from the amazon frontier. In: JAMA health collation system analysis in mail-order pharmacy automation

13
362
system. In: IIE Annual conference, proceedings institute of
industrial and systems engineers (IISE), pp 828–833
17. Dauod H, Wang H, Khader N, Yoon SW, Srihari K (2017) Real-
time dispenser replenishment optimization based on receding
horizon control. Procedia Manufacturing 11:1782–1789
18. Serhan D, Dauod H, Yoon SW (2018) Sequential modeling
and optimization for resources in mail-order pharmacy automa-
tion systems. In: IIE Annual conference, proceedings insti-
tute of industrial and systems engineers (IISE), pp 1223–
1228
19. Dauod H, Serhan D, Wang H, Khader N, Yoon SW, Srihari K
(2019) Robust receding horizon control strategy for replenishment
planning of pharmacy robotic dispensing systems. Robot Comput
Integr Manuf 59:177–188
20. O’Connor R, Yoon SW, Kwon S (2021) Analysis and optimization
of replenishment process for robotic dispensing system in a central
fill pharmacy. Comput Ind Eng 154(107):116
13
N. Cao et al.
21. Wang H, Serhan DM, Yoon SW, Lashier A (2016) Collation
delay optimization using discrete event simulation in mail-order
pharmacy automation systems. In: Proceedings of the 2016
industrial and systems engineering research conference
22. Rockwell Automation lnc (2022) Emulate3d by rockwell automa-
tion https://www.demo3d.com/
23. Monks T, Currie CS, Onggo BS, Robinson S, Kunc M, Taylor
SJ (2019) Strengthening the reporting of empirical simulation
studies: Introducing the stress guidelines. J Simul 13(1):55–67
Publisher’s note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Springer Nature or its licensor (e.g. a society or other partner) holds
exclusive rights to this article under a publishing agreement with the
author(s) or other rightsholder(s); author self-archiving of the accepted
manuscript version of this article is solely governed by the terms of
such publishing agreement and applicable law.