Patent Publication Number: US-2021161767-A1

Title: Automatic packager for pharmaceuticals and method of operating the same

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to U.S. Provisional Application No. 62/652,692, filed on Apr. 4, 2018, and U.S. Provisional Application No. 62/745,126, filed on Oct. 12, 2018, the entire contents of which are hereby incorporated by reference for all purposes. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to pharmaceutical packaging machines and, more particularly, verification systems for packaging machines. 
     SUMMARY 
     One embodiment provides a method for filling a prescription in a pharmacy. The method includes receiving, at an electronic processor of a pharmacy management system, a prescription to be filled by the pharmacy management system and identifying, at a pre-counter, one or more bulk containers that contain medications to fill the prescription. The method also includes counting, using the pre-counter, medications from the one or more bulk containers to fill the prescription and depositing the counted medications in one or more cartridges. The method also includes placing the one or more cartridges including the counted medications at an automatic packager and dispensing, using the automatic packager, the medications in the one or more cartridges. The method also includes packaging, using a packaging unit of the automatic packager, medications dispensed from the one or more cartridges into packages and verifying, using the automatic packager, whether the medications are correctly packaged. 
     Another embodiment provides a method for filling a prescription in a pharmacy. The method includes receiving, at an electronic processor of a pharmacy management system, a prescription to be filled by the pharmacy management system and identifying, at a pre-counter, one or more bulk containers that contain medications to fill the prescription. The method also includes counting, using the pre-counter, medications from the one or more bulk containers to fill the prescription and prompting, using the pre-counter, to add or remove pills from the pre-counter. The method also includes depositing the counted medications in one or more cartridges and placing the one or more cartridges including the counted medications at an automatic packager. The method also includes verifying, using the automatic packager, each medication as the medication is dispensed from the one or more cartridges and packaging, using a packaging unit of the automatic packager, medications dispensed from the one or more cartridges into packages. 
     Another embodiment provides a method for filling a prescription in a pharmacy. The method includes receiving, at an electronic processor of a pharmacy management system, a prescription to be filled by the pharmacy management system and identifying, at a pre-counter, one or more bulk containers that contain medications to fill the prescription. The method also includes counting, using the pre-counter, medications from the one or more bulk containers to fill the prescription and packaging, using a packaging unit of the automatic packager, medications counted at the pre-counter. The method also includes capturing one or more images of the medications counted at the pre-counter and verifying, using the automatic packager, whether the medications are correctly packaged based on the one or more images of the medications. 
     Another embodiment provides a method for filling a prescription in a pharmacy. The method includes receiving, at an electronic processor of a pharmacy management system, a prescription to be filled by the pharmacy management system and placing one or more cartridges including medications listed on the prescription at an automatic packager. The method also includes singulating, using the automatic packager, the medications in the one or more cartridges for individually dispensing the medications and verifying, using the automatic packager, each medication while the medication is in the one or more cartridges or as the medication is dispensed from the one or more cartridges. The method also includes capturing an image of the each medication as the medication is dispensed from the one or more cartridges and packaging, using a packaging unit of the automatic packager, medications dispensed from the one or more cartridges into packages. The method also includes verifying, using the automatic packager, whether the medications are correctly packaged. 
     Another embodiment provides a method for filling a prescription in a pharmacy. The method includes receiving, at an electronic processor of a pharmacy management system, a prescription to be filled by the pharmacy management system and identifying, at a pre-counter, one or more bulk containers that contain medications to fill the prescription. The method also includes counting, using the pre-counter, medications from the one or more bulk containers to fill the prescription and determining, using the pre-counter, one or more characteristics of the medications listed on the prescription. The method also includes transmitting, using the pre-counter, the one or more characteristics of the medications to the automatic packager. The automatic packager verifies the correct medications are packaged by the packaging unit based on the one or more characteristics of the medications received from the pre-counter. 
     Another embodiment provides a method for filling a prescription in a pharmacy. The method includes receiving, at an electronic processor of a pharmacy management system, a prescription to be filled by the pharmacy management system, and identifying, at a pre-counter, one or more bulk containers that contain medications to fill the prescription. The method also includes counting, using the pre-counter, medications from the one or more bulk containers to fill the prescription, and packaging, using a packaging unit of an automatic packager, medications counted at the pre-counter. 
     Other aspects of the invention will become apparent by consideration of the detailed description and accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a schematic of a pharmacy management system in accordance with some embodiments. 
         FIG. 2  is a perspective view of a pharmaceutical storage and retrieval system of the pharmacy management system of  FIG. 1 , the system having three storage and retrieval devices in accordance with some embodiments. 
         FIG. 3  is a schematic of the pharmaceutical storage and retrieval system illustrated in  FIG. 2  in accordance with some embodiments. 
         FIG. 4  is a perspective view of a user access assembly of the pharmaceutical storage and retrieval system of  FIG. 2  in accordance with some embodiments. 
         FIG. 5  is a perspective view of a pre-counter for an automatic packager of the pharmacy management system of  FIG. 1  in accordance with some embodiments. 
         FIG. 6  is a schematic of the pre-counter for an automatic packager of  FIG. 5  in accordance with some embodiments. 
         FIG. 7  is a perspective view of an automatic packager of the pharmacy management system of  FIG. 1  in accordance with some embodiments. 
         FIG. 8A  is a perspective view of a cartridge of the automatic packager of  FIG. 7  in accordance with some embodiments. 
         FIG. 8B  is a plan view of the cartridge of  FIG. 8A  with a side portion removed in accordance with some embodiments. 
         FIG. 8C  is a perspective view of the cartridge of  FIG. 8A  in accordance with some embodiments. 
         FIG. 9  is a plan view of a packaging unit of the automatic packager of  FIG. 7  in accordance with some embodiments. 
         FIG. 10  is a schematic of the automatic packager of  FIG. 7  in accordance with some embodiments. 
         FIG. 11  is a flowchart of a method of pre-counting medications for filling a prescription in accordance with some embodiments. 
         FIG. 12  is a flowchart of a method of filling a prescription in accordance with some embodiments. 
         FIG. 13  is a perspective view of a pre-counter for an automatic packager of the pharmacy management system of  FIG. 1  in accordance with some embodiments. 
         FIG. 14  is a flowchart of a method of filling cartridges in accordance with some embodiments. 
         FIG. 15  is a flowchart of a method of filling a prescription in accordance with some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     Before any embodiments of the invention are explained in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of components set forth in the following description or illustrated in the following drawings. The invention is capable of other embodiments and of being practiced or of being carried out in various ways. Also, the functionality described herein as being performed by one component may be performed by multiple components in a distributed manner. Likewise, functionality performed by multiple components may be consolidated and performed by a single component. Similarly, a component described as performing particular functionality may also perform additional functionality not described herein. For example, a device or structure that is “configured” in a certain way is configured in at least that way but may also be configured in ways that are not listed. 
     Most health treatments require several medications to be administered at particular times during the day. Treatments are not effective if all the required medications are not taken together at the prescribed time. To improve adhesion to a prescription, some pharmacies provide medications in labeled strip packages. Each strip package includes all the different types of medications that should be taken together at the labeled time. Typically, each prescription is provided for medications for the next 30 days. Accordingly, each spool of strip packages includes medications that are provided for the next 30 days. 
     Each of the strip packages may need to be checked manually to ensure that the correct types and number of medications are included in the strip package. Typically, the strip packages are checked after all of the medications are packaged and removed from the packager. However, if an error was discovered after packaging and labelling, the strip package may need to be removed from the spool and replaced by a correctly packaged and labeled strip package. This provides a break in the spool and is generally inefficient. Additionally, the above method only provides a single opportunity for a pharmacist to identify errors in packaging. 
     Accordingly, improving the efficiency of verifying the accuracy of packaging and for providing additional opportunities for a pharmacist to efficiently identify or reduce errors in packaging may be desired. Additionally, improving the efficiency in packaging allows the pharmacist to serve additional customers by reducing the amount of time it takes to serve the customers. 
       FIG. 1  is a schematic illustration of a pharmacy management system  10  according to one example embodiment. The pharmacy management system  10  is a pharmacy automation system for use in retail pharmacies. The pharmacy management system  10  allows for automation of stocking the pharmacy, filling prescriptions, and inventory control performed in retail pharmacies. In the example illustrated in  FIG. 1 , the pharmacy management system  10  includes an electronic processor  14 , a memory  18 , a transceiver  22 , an input/output interface  26 , a pharmaceutical storage and retrieval system  30 , a pre-counter  34 , and an automatic packager  38 . The electronic processor  14 , the memory  18 , the transceiver  22 , and the input/output interface  26  communicate over one or more control and/or data buses (e.g., a communication bus  42 ).  FIG. 1  illustrates only one exemplary embodiment of the pharmacy management system  10 . The pharmacy management system  10  may include more or fewer components and may perform functions other than those explicitly described herein. For example, in some embodiments, the pharmacy management system  10  may not include the pharmaceutical storage and retrieval system  30 . 
     In some embodiments, the electronic processor  14  is implemented as a microprocessor with separate memory, such as the memory  18 . In other embodiments, the electronic processor  14  may be implemented as a microcontroller (with memory  18  on the same chip). In other embodiments, the electronic processor  14  may be implemented using multiple processors. In addition, the electronic processor  14  may be implemented partially or entirely as, for example, a field-programmable gate array (FPGA), an application specific integrated circuit (ASIC), and the like, and the memory  18  may not be needed or be modified accordingly. In the example illustrated, the memory  18  includes non-transitory, computer-readable memory that stores instructions that are received and executed by the electronic processor  14  to carry out functionality of the pharmacy management system  10  described herein. The memory  18  may include, for example, a program storage area and a data storage area. The program storage area and the data storage area may include combinations of different types of memory, such as read-only memory and random-access memory. 
     The transceiver  22  enables wired or wireless communication from the pharmacy management system  10  to a communication network  46 . In other embodiments, rather than the transceiver  22 , the pharmacy management system  10  may include separate transmitting and receiving components, for example, a transmitter and a receiver. The pharmacy management system  10 , through the communication network  46 , may communicate with the pharmaceutical storage and retrieval system  30 , the pre-counter  34 , the automatic packager  38 , and databases, for example, the National Drug Code (NDC) database  50 . 
     The communication network  46  can be built according to any suitable networking technology or topology or combinations of technologies and topologies and can include multiple sub-networks. Connections between the devices and systems shown in  FIG. 1  can be made through local area networks (“LANs”), wide area networks (“WANs”), public switched telephone networks (“PSTNs”), wireless networks, Intranets, the Internet, or any other suitable networks. In a hospital or medical care facility, for example, communication between the devices and systems shown in  FIG. 1  can be made through any required communication protocol(s), including, for example, the Health Level Seven (“HL7”) protocol or any other version of a required protocol. The HL7 protocol is a standard protocol which specifies the criteria for data exchange (including the required interface implementation) between two computer applications (sender and receiver), such that a universal standard is used by vendors, thereby facilitating the exchange of electronic data in health care environments. The HL7 protocol allows health care institutions to exchange key sets of data from different application systems. Specifically, the HL7 protocol can define the data to be exchanged, the timing of the interchange, and the communication of errors to the application. The formats are generally generic in nature and can be configured to meet the needs of the applications involved. 
       FIG. 2  illustrates a pharmaceutical storage and retrieval system  30  according to one example embodiment. The pharmaceutical storage and retrieval system  30  is a comprehensive workflow automation and high density robotic storage system for use in retail pharmacies. The system  30  seamlessly dispenses prescription containers and returns the containers to inventory without requiring operators to use a complicated software interface. As illustrated in  FIG. 1 , the pharmaceutical storage and retrieval system  30  includes one or more pharmaceutical storage and retrieval devices  54  and a computer or controller configured to control the operations and functionality of the pharmaceutical storage and retrieval device  54 . Although the system  30  shown in  FIG. 1  includes three pharmaceutical storage and retrieval devices  54 , more or fewer devices  54  can be utilized in a particular pharmaceutical storage and retrieval system  30 . Similar pharmaceutical storage and retrieval systems  30  are described and illustrated in U.S. Pat. No. 9,727,701, entitled “PHARMACEUTICAL STORAGE AND RETRIEVAL SYSTEM AND METHODS OF STORING AND RETRIEVING PHARMACEUTICALS,” the entire contents of which are hereby incorporated by reference. 
       FIG. 3  schematically illustrates the pharmaceutical storage and retrieval system  30  and its functionality within a pharmacy. In the example illustrated, the pharmaceutical storage and retrieval system  30  includes a storage electronic processor  58 , a storage memory  62 , a storage transceiver  66 , an RFID scanner  70 , a biometric scanner  74 , a barcode scanner  78 , and a storage input/output interface  82 . The storage electronic processor  58 , the storage memory  62 , the storage transceiver  66 , the RFID scanner  70 , the biometric scanner  74 , the barcode scanner  78 , and the storage input/output interface  82  communicate over one or more control and/or data buses (e.g., a communication bus  86 ).  FIG. 3  illustrates only one exemplary embodiment of the pharmaceutical storage and retrieval system  30 . The pharmaceutical storage and retrieval system  30  may include more or fewer components and may perform functions other than those explicitly described herein. 
     The storage electronic processor  58  and the storage memory  62  may be implemented similar to the electronic processor  14  and the memory  18  as described above. The storage transceiver  66  enables communication from the pharmaceutical storage and retrieval system  30  to the communication network  46 . In other embodiments, rather than the storage transceiver  66 , the pharmaceutical storage and retrieval system  30  may include separate transmitting and receiving components, for example, a transmitter and a receiver. The pharmaceutical storage and retrieval system  30  through the communication network  46  may communicate with the pre-counter  34 , the automatic packager  38 , and databases, for example, the National Drug Code database  50 . 
     The storage input/output interface  82  may include one or more input mechanisms (e.g., a touch screen, a keypad, a button, a knob, and the like), one or more output mechanisms (e.g., a display, a printer, a speaker, and the like), or a combination thereof. The storage input/output interface  82  receives input from the input devices actuated by a user, and provides output to the output devices with which a user interacts. In some embodiments, as an alternative or in addition to managing inputs and outputs through the storage input/output interface  82 , the pharmaceutical storage and retrieval system  30  may receive user inputs, provide user outputs, or both by communicating with an external device, such as a console computer, over a wired or wireless connection. 
     As shown in  FIG. 4 , the pharmaceutical storage and retrieval system  30  also includes a user authorization system  94 . The user authorization system  94  includes the RFID scanner  70 , the biometric scanner  74 , and the barcode scanner  78 . The RFID scanner  70  is integral with the user authorization system  94 . In alternate embodiments, the RFID scanner  70  can be separately located proximate the device  54 . The biometric scanner  74  is used to identify an authorized user of the system  30  and can be, for example, a fingerprint scanner, an iris reader, a voice recognition scanner, a facial recognition scanner, or combinations thereof. 
     The barcode scanner  78  can be used to read barcodes such as the NDC on the containers or the labels on custom containers stored in the pharmaceutical storage and retrieval system  30 . The barcode scanner  78  can also be used to scan unique barcode labels generated by the system  30  to identify individual containers of particular pharmaceuticals. In such embodiments, the system  30  generates a barcode that is uniquely assigned to each container that is stored in the device  54 . As each container is first introduced into the device  54 , a label bearing the system  30  generated barcode is affixed to the container. Thereafter each time the container is “checked out” or “checked in” to the system  30 , the system  30  cannot only identify the type of medication being “checked out” or “checked in,” but can further track the specific container. Accordingly, such embodiments of the system  30  allow multiple containers of the same pharmaceutical or medication to be “checked out” of the system  30  at the same time. Because the system  30  can identify each specific container, the system  30  can associate each container with, for example, a specific operator or a specific prescription order to verify that the order was properly completed. 
     Referring to  FIG. 3 , the storage electronic processor  58  may implement a fill prescription module for the pharmaceutical storage and retrieval system  30 . In some embodiments, the fill prescription module is operable to retrieve a specific container to fill a customer&#39;s prescription from the system  30  using an automated process. In other embodiments, as noted above, the system  30  may be omitted. In such embodiments, a user may manually retrieve the specific container(s) from a location within a pharmacy, such as a closet or shelf. In scenarios where the system  30  is used to retrieve the specific container(s), when the pharmacy receives a prescription to fill, pharmacy personnel enters the information into the pharmacy management system  10 , where the pharmacy printer generates an information sheet that includes a list of medications, customer information, and a barcode. The information sheet is taken to the scanner  78  where the barcode is read. At the same time, the user&#39;s RFID credential can be read to confirm authorization to the system  30  and the pharmaceuticals stored within. Based on the barcode, the fill prescription module instructs a gantry assembly of the pharmaceutical storage and retrieval device  54  to retrieve the container needed to fill the customer&#39;s prescription and identified on the information sheet. More specifically, the fill prescription module communicates with the storage memory  62  to obtain the particular location where the needed container of medication is stored within the device  54 . The fill prescription module further communicates the particular location of the container to the gantry assembly so the gantry assembly knows where to go to retrieve the appropriate container. In the instance where a particular container is stored outside the device  54 , an external storage location associated with the desired container can be communicated to the operator. 
     After identifying the particular location of the needed container, the gantry assembly retrieves the container and inserts it into a port  98  of the device  54 . After the user&#39;s RFID credentials are verified, a front door opens to allow the user to remove the container from the port  98 . The pharmacy management system  10  can also communicate the order information directly to the storage electronic processor  58  of system  30 , which can direct the device  54  to begin retrieving and staging containers needed for the entered orders. Similar to the process described above, the user can take an information sheet generated by the pharmacy printer to the scanner  78  where the information sheet barcode and the user&#39;s RFID are read. If the system  30  recognizes a valid RFID credential and a barcode on the presented information sheet associated with a staged order, the port(s)  74  containing the pharmaceutical(s) needed to fill the order are opened. Accordingly, the system  30  can be configured to retrieve, but not allow access to the needed pharmaceuticals before the information sheet and RFID are scanned. 
     In scenarios where the system  30  is not present, when the pharmacy receives a prescription to fill, pharmacy personnel may still enter the information into the pharmacy management system  10  where the pharmacy printer generates in an information sheet. In this embodiment, however, the information sheet may not include a barcode to be scanned by a pharmaceutical storage and retrieval system  30 . Instead, the information sheet may include a list of medications and customer information. The user may then manually retrieve bulk storage containers containing the desired medications from a storage location (e.g., a closet, a cabinet, a shelf, etc.). Alternatively, the user may directly retrieve the desired bulk storage containers without first entering the information into the pharmacy management system  10  and generating the information sheet. 
       FIG. 5  illustrates a pre-counter  34  for the automatic packager  38  according to one example embodiment. The pre-counter  34  is a medication counting device for use in retail pharmacies that detects and counts a number of medications that are placed on the pre-counter  34 . The pre-counter  34  displays the count and shares the count with other systems within the pharmacy. As illustrated in  FIG. 5 , the pre-counter  34  includes a barcode scanner  102 , a counting tray  106 , a camera system  110 , a display  114 , a funnel  118 , and a funnel gate  122 . 
     The barcode scanner  102  is used to scan a barcode on a label of a container retrieved from the device  54  or other location within the pharmacy and may be implemented similar to the barcode scanner  78 . Although the illustrated scanner  102  is identified as a barcode scanner, in other embodiments, the pre-counter may include other types of scanners, such as a scanner for recognizing a Q-code on a bottle or a camera for recognizing an image of or on the bottle. In further embodiments, the scanner  102  may be omitted and a user may directly enter information regarding a bottle into the pre-counter (e.g., a serial number of the bottle via a keypad). The contents of the container may then be placed on the counting tray  106  for counting by the pre-counter  34 . The counting tray  106  may be replaceable for cleaning and to inhibit cross-contamination between different types of medications. The counting tray  106  may be transparent or translucent such that a lighting system  126  (see  FIG. 6 ) underneath the counting tray  106  can illuminate the contents of the counting tray  106 . Once illuminated, the camera system  110  may capture an image of the contents of the counting tray  106  to commence counting. The display  114  may be used to display the scanned barcode information and to display the count of the medications placed on the counting tray  106 . Based on the displayed information, a pharmacist or technician may add or remove medications from the counting tray  106  until the correct amount of medications is placed on the counting tray  106 . When the correct amount of medications is placed on the counting tray  106 , the user may transfer the contents of the counting tray  106  to a cartridge  158  ( FIG. 7 ) of the automatic packager  38 . The funnel  118  and funnel gate  122  are used to transfer the medications from the counting tray  106  to the original container or to the cartridge  158 . 
       FIG. 6  schematically illustrates the pre-counter  34  and its functionality within a pharmacy. In the example illustrated, the pre-counter  34  includes a counter electronic processor  130 , a counter memory  134 , a counter transceiver  138 , the barcode scanner  102 , the camera system  110 , the display  114 , the lighting system  126 , and a counter input/output interface  142 . The counter electronic processor  130 , the counter memory  134 , the counter transceiver  138 , the barcode scanner  102 , the camera system  110 , the display  114 , the lighting system  126 , and the counter input/output interface  142  communicate over one or more control and/or data buses (e.g., a communication bus  146 ).  FIGS. 5 and 6  illustrate only one exemplary embodiment of the pre-counter  34 . The pre-counter  34  may include more or fewer components and may perform functions other than those explicitly described herein. 
     The counter electronic processor  130  and the counter memory  134  may be implemented similar to the storage electronic processor  58  and the storage memory  62  as described above. The counter transceiver  138  enables communication from the pre-counter  34  to the communication network  46 . In other embodiments, rather than the counter transceiver  138 , the pre-counter  34  may include separate transmitting and receiving components, for example, a transmitter and a receiver. The pre-counter  34  through the communication network  46  may communicate with the pharmaceutical storage and retrieval system  30 , the automatic packager  38 , and databases, for example, the National Drug Code database  50 . 
     The counter input/output interface  142  may include one or more input mechanisms (e.g., a touch screen, a keypad, a button, a knob, and the like), one or more output mechanisms (e.g., a display, a printer, a speaker, and the like), or a combination thereof. The counter input/output interface  142  receives input from the input devices actuated by a user, and provides output to the output devices with which a user interacts. In some embodiments, as an alternative or in addition to managing inputs and outputs through the counter input/output interface  142 , the pre-counter  34  may receive user inputs, provide user outputs, or both by communicating with an external device, such as a console computer, over a wired or wireless connection. 
     The lighting system includes a first light source  147  and a second light source  148 . The first light source  147  (e.g., an infrared (IR) or near infrared (NOR) spectrum light) is positioned under the counting tray  106 . The first light source  147  shines light through the counting tray  106  toward the camera system  110  to illuminate the contents of the counting tray  106 . When the first light source  147  illuminates the counting tray  106 , the medications on the counting tray  106  form shadows against a white background of the first light source  147  or the counting tray  106 . The camera system  110  captures an image of the shadows cast by the medications on the counting tray  106 . The image may be a still image of the medications at a specific instance of time, or may be live image that is continuously transmitted to the display  114 . The second light source  148  (e.g., a visible spectrum light) is positioned on the same side of the counting tray  106  as the camera system  110  to shine light on the counting tray  106  and illuminate the contents of the counting tray  106 . When the second light source  148  illuminates the counting tray  106 , the camera system  110  captures a visible light image of the medications, showing the color, shape, contour, surface finish, etc. of the medications. The image may be a still image of the medications at a specific instance of time, or may be a live image that is continuously transmitted to the display  114 . The camera system  110  communicates with the counter electronic processor  130  and the counter memory  134  to store the images and/or transmit the images to the display  114 . 
       FIG. 7  illustrates an example automatic packager  38  including a universal feed cassette  150  and a packaging unit  154  according to an example embodiment. The universal feed cassette  150  receives medications from the bulk canisters or the pre-counter  34  and individually dispenses pills to the packaging unit  154 . Each universal feed cassette  150  may dispense ten separate pills at the same time. In other embodiments, the universal feed cassette  150  may dispense twenty or more separate pills at the same time. In some embodiments, the automatic packager  38  may include more than one universal feed cassette  150 . 
     The universal feed cassette  150  includes a plurality of cartridges  158  arranged within the housing of the universal feed cassette  150 . In one example, the universal feed cassette  150  may include up to ten cartridges  158  that are received in cartridge slots  162 . In another example, the universal feed cassette  150  may include up to twenty cartridges  158  that are received in the cartridge slots  162 . For example, the cartridges  158  may be received in two levels or tiers of cartridge slots  162 . A pharmacist may load medications from bulk canisters or the pre-counter  34  into each of the cartridges  158 . The same medications may be loaded into each cartridge  158 , or different medications may be loaded into each cartridge  158 . The cartridges  158  independently dispense the medications to the packaging unit  154 . 
     The cartridges  158  are removably fixed to the universal feed cassette  150 . A pharmacist or technician may remove each individual cartridge  158  from the cartridge slot  162  to fill the cartridge  158  with medications from the pre-counter  34 . The cartridge  158  can then be placed into any of the cartridge slot  162 . 
     An example cartridge  158  is described in U.S. patent application Ser. No. 16/160,535, filed on Oct. 15, 2018, entitled “UNIVERSAL FEED MECHANISM FOR AUTOMATIC PACKAGER,” the entire contents of which are hereby incorporated by reference. In other embodiments, other suitable cartridges may also or alternatively be used. In the example illustrated in  FIG. 7 , the packaging unit is a strip packager. An example strip packager is described in U.S. Patent Application Publication No. 2013/031891 and U.S. Patent Application Publication No. 2017/0015445, the entire contents of both of which are hereby incorporated by reference. In other embodiments, other suitable packaging units, including strip packagers, blister card packagers, and the like, may also or alternatively be used. 
       FIGS. 8A-C  illustrates one example embodiment of the cartridge  158 . In the example illustrated, the cartridge  158  includes a reservoir  850 , a wheel  860 , and scooping members  865 . The reservoir  850  stores the medications during the dispensing process. The wheel  860  is provided on one side of the cartridge  158  and extends into the bottom portion of the reservoir  850 . The bottom portion of the reservoir  850  has a curved shape starting from the side opposite that of the wheel  860 , the front side, and the back side and ending at the center of the bottom portion of the wheel  860 . The curved shape of the reservoir  850  directs the medications within the reservoir  850  towards the bottom of the wheel  860  and particularly into the scooping members  865  of the wheel  860 . 
     Teeth  875  are provided on the outer circumferential surface of the wheel  860 . During the dispensing process, the teeth  875  interlock with teeth of a shaft driven by a motor assembly of the cartridge mechanism  845 . The wheel  860  is provided with three scooping members  865  to scoop individual medications from the reservoir  850 . The scooping members  865  include an inward projection  866  extending into the wheel  860 . The curved surface of the reservoir  850  guides the medications into the inward projections  866  of the scooping members  865 . The scooping members  865  include a stopper  868  along a circumferential end of the inward projections  866  that hold the medications when the wheel  860  is being rotated. 
     The wheel  860  includes holding pins  880  that extend and retract from the inside of the wheel  860  during rotation of the wheel  860 . The scooping members  865  include an opening to receive the holding pins  880 . The holding pins  880  along with the stopper  868  and the circumferential surface of the inward projection  866  are used to hold a medication when the wheel  860  is being rotated. During rotation of the wheel  860 , when the inward projections  866  of the scooping members  865  encounter the reservoir  850 , the medications in the reservoir  850  move inward into the scooping members  865  due to the curved shape of the reservoir  850 . The holding pins  880  are retracted when the scooping members  865  are moving along the reservoir  850  at a bottom portion of the wheel  860 . As the scooping members  865  move out of the reservoir  850 , the holding pins  880  are advanced towards the circumferential end of the scooping members  865  to engage a medication. The medications are held between the circumferential end of the scooping member  865 , the holding pin  880 , and the stopper  868 . The scooping member  865  and the holding pin  880  can be used for any type of medication. Typically, only a single medication is pinched between the holding pin  880  and the scooping member  865 , while the other medications fall back into the reservoir  850  during the rotation of the wheel  860 . As the scooping member  865  passes the top portion of the wheel  860 , the holding pin  880  is once again retracted to release the medication into a shuttle system. The wheel  860  and the scooping member  865  may together be referred to as a singulating mechanism. 
     The cartridge  158  also includes a shuttle system, a camera system, and a motor assembly. The shuttle system includes a platform  920 , a shuttle  925 , and a shuttle drive  930 . The platform  920  may be made from a clear or translucent plastic material. An LED lighting system  922  may be provided over and/or under the platform  920  to illuminate the contents on the platform  920  when the camera system is capturing an image of the contents. The LED lighting system  922  may emit visible or infrared light to illuminate the platform  920 . The shuttle  925  may be moved laterally between the platform  920 , over the reservoir  850 , and over a conduit. The shuttle  925  transfers the medications from the platform  920  either to the reservoir  850  or to the conduit. The shuttle  925  is driven by the shuttle drive  930 . The shuttle drive  930  may be a motor assembly, an actuator, or the like that moves the shuttle  925  between the platform  920 , over the reservoir  850 , and over the conduit. In the example illustrated, the shuttle drive  930  includes a rotating screw  932  that moves the shuttle  925  laterally between the platform  920 , the reservoir  850 , and the conduit. 
     The camera system includes a camera  940  and a mirror  945 . The camera  940  is positioned at the back of the cartridge mechanism  845 . The camera  940  may be a still camera or a video camera that captures an image of the contents of the platform  920 . The mirror  945  is placed directly above the platform  920  and is tilted at a 45-degree angle such that the camera  940  positioned at the back of the cartridge mechanism  845  can capture an image of the platform  920 . 
     In some embodiments, the camera system is operable in a learning mode to create a database of images of medications currently in the cartridge  158 . For example, as each medication is singulated by the wheel  860 , the camera  940  captures an image of the medication, the image is stored in a database, and the shuttle  925  returns the medication to the reservoir  850 . This process may be repeated, for example, 50-100 times to capture images of the medications in different orientations. 
     The motor assembly includes a motor  950  that drives a shaft  955  positioned in the middle of the cartridge mechanism  845 . The shaft  955  includes teeth  956  that interlock with the teeth  875  of the wheel  860 . When the motor  950  is driven, the shaft  955  rotates the wheel  860  to the individually dispense the medications  180 . 
     The cartridge  158  may include an RFID tag that may be used to identify the cartridge  158 . The RFID tag may be read by an RFID reader of the pre-counter  34  or the automatic packager  38 . 
       FIG. 9  illustrates one embodiment of the packaging unit  154 . In the example illustrated, the packaging unit  154  includes a manifold  170 , a receptacle  174 , two feed stock rolls  178 ,  182 , a take-up roll, and a verification system  186 . The universal feed cassette  150  is placed on top of the manifold  170 . The manifold  170 , or chute, includes a plurality of discrete tracks corresponding to each of the cartridges  158  (particularly, a conduit of each cartridge  158 ) mounted on the manifold  170 . The illustrated tracks are independent channels that together form the manifold  170 . The tracks direct pharmaceuticals from the universal feed cassette  150  toward packaging equipment of the packaging unit  154 . Conduits of the cartridges  158  align with holes in the manifold  170  such that medications slide down the manifold  170  toward the packaging equipment. The tracks  190  isolate the medications from each other as the medications slide down the manifold  170  to the receptacle  174 . 
     The receptacle  174  collects the medications from the manifold  170 . After the medications pass through to the receptacle  174 , the medications are sandwiched between two strips of material (e.g., plastic, paper, etc.) from the feed stock rolls  178 ,  182 . The first feed roll  178  may be made of a first material that is white in color (e.g., a translucent material). The second feed roll  182  may be made of a second material that is clear (e.g., a transparent material) to allow a pharmacist to look through the pouch to see the medications inside the pouch. The two strips of material are then heat sealed together to form a pouch for the medications. In some embodiments, the packaging unit  154  may include a single feed stock roll having a single strip of material that is folded and/or heat sealed to form pouches. Once filled and sealed, the pouches are wrapped around the take-up roll to create a single spool of pouches. The spool may correspond to medications requested by a particular patient or a particular facility. In other embodiments, the pouches may be cut and separated as they are filled, rather than spooled onto the take-up roll continuously. The pouches are dispensed through, for example, a dispenser or dispensing port connected. 
     In some embodiments, the packaging unit  154  may include a printer  194  to print a patient&#39;s name, the date, the amount and type of medications contained within, a barcode, and/or other indicia on the pouches as the pouches are formed. The printer  194  may be, for example, a thermal printer. In other embodiments, the printer  194  may include an ink ribbon or an ink jet. In addition, the packaging unit  154  may include a verification system  186  to monitor and check the pouches as they are spooled onto the take-up roll or dispensed. 
       FIG. 10  schematically illustrates one embodiment of the automatic packager  38 . The automatic packager  38  controls operations of the feed stock rolls  178 ,  182  to release and form a pharmaceutical pouch, and controls when the active cartridges  158  positioned on the manifold  170  are operated. 
     In the example illustrated, the automatic packager  38  includes a packager electronic processor  202 , a packager memory  206 , a packager transceiver  210 , a packager input/output interface  214 , the motors  166 , the cameras  168 , the printer  194 , and the verification system  186 . The packager electronic processor  202 , the packager memory  206 , the packager transceiver  210 , the packager input/output interface  214 , the motors  166 , the cameras  168 , the printer  194 , and the vision system 198  communicate over one or more control and/or data buses (e.g., a communication bus  218 ).  FIG. 10  illustrates only one exemplary embodiment of the automatic packager  38 . The automatic packager  38  may include more or fewer components and may perform functions other than those explicitly described herein. 
     The packager electronic processor  202  and the packager memory  206  may be implemented similar to the storage electronic processor  58 , the counter electronic processor  130 , the storage memory  62 , and the counter memory  134  respectively, as described above. The packager transceiver  210  enables communication from the automatic packager  38  to the communication network  46 . In other embodiments, rather than the packager transceiver  210 , the automatic packager  38  may include separate transmitting and receiving components, for example, a transmitter and a receiver. The automatic packager  38 , through the communication network  46 , may communicate with the pharmaceutical storage and retrieval system  30 , the pre-counter  34 , and databases, for example, the National Drug Code database  50 . 
     As noted above, the automatic packager  38  may include the packager input/output interface  214  (or more commonly referred to as a user interface). The packager input/output interface  214  may include one or more input mechanisms (e.g., a touch screen, a keypad, a button, a knob, and the like), one or more output mechanisms (e.g., a display, a printer, a speaker, and the like), or a combination thereof. The packager input/output interface  214  receives input from the input devices actuated by a user, and provides output to the output devices with which a user interacts. In some embodiments, as an alternative or in addition to managing inputs and outputs through the packager input/output interface  214 , the automatic packager  38  may receive user inputs, provide user outputs, or both by communicating with an external device, such as a console computer, over a wired or wireless connection. 
     One advantage of the cartridges  158  is that the cartridges  158  significantly reduce the packaging time compared to prior cartridges. Some prior cartridges had to be manually filled one pill at a time by a pharmacist or a technician. In contrast, the pharmacist or technician may simply dump pills from a bulk container into the cartridge  158  and place the cartridge  158  in the universal feed cassette  150 . The automatic packager  38  then retrieves medications from the cartridge  158 . Typically, a pharmacist or technician may have to overfill the cartridge  158  to ensure that sufficient medications are available in the cartridge  158  to fill the prescription without having to refill the cartridge  158 . Once the medications are packaged, the pharmacist or technician returns the unused medications to the bulk container. However, this introduces an inefficiency into the system  10  where the bulk container needs to be outside the storage area until the packaging process is completed to receive any excess medications from the cartridges  158 . The pre-counter  34  helps overcome this inefficiency by allowing a pharmacist to quickly and efficiently count the exact number of pills required to fill the prescription and return the bulk container to storage. 
       FIG. 11  depicts a method  230  of pre-counting medications for filling a prescription. Although the method  230  includes specific blocks, all the blocks need not be performed or performed in the order presented. When the pharmacist receives a prescription from a customer, the pharmacy management system  10  generates an information sheet including a list of all the medications required to fill the prescription. The pharmacist uses the information sheet to retrieve bulk containers including the medications in the information sheet. For example, the pharmacist retrieves the bulk container from the pharmaceutical storage and retrieval system  30  or from storage shelves in the pharmacy. 
     At block  234 , the method  230  includes scanning, using the counter electronic processor  130  with the barcode scanner  102 , a bulk storage container with a barcode to identify the type of medication in the bulk storage container. Once the pharmacist retrieves the bulk storage containers, the pharmacist scans the bulk storage containers at the pre-counter  34 . The barcode scanner  102  scans the barcode on the bulk storage containers and provides the identification information read from the barcode to the counter electronic processor  130 . The counter electronic processor  130  retrieves information pertaining to the medication within the bulk storage container using the identification information. For example, the counter electronic processor  130  communicates with the NDC database  50  to determine the type, the weight, the size, the color, etc. of the medication within the bulk storage container. Scanning the bulk storage containers at the pre-counter  34  also verifies that the correct bulk storage containers were retrieved. 
     At block  238 , the method  230  includes counting, using the counter electronic processor  130  with the camera system  110 , the number of medications on the counting tray  106  of the pre-counter  34 . After scanning a bulk storage container, the pharmacist pours medications from the bulk storage container onto the counting tray  106 . The counter electronic processor  130  activates the first light source  147  to illuminate the counting tray  106  and continuously captures an image of the counting tray  106  using the camera system  110  to determine the number of medications on the counting tray  106 . In some embodiments, the first light source  147  may always be turned on when the pre-counter  34  is turned on. As described above, the first light source  147  is an IR or a NIR light source that cast shadows of the medications against a white background. The counter electronic processor  130  processes the image captured by the camera system  110  using known image processing systems to determine the number of medications on the counting tray  106 . Particularly, the counter electronic processor  130  analyzes the shadows cast by the medications to determine the number of medications on the counting tray  106 . In some embodiments, the pre-counter  34  continuously captures the image of the counting tray  106  at regular time intervals (e.g., every 0.5 seconds) to update the count of the medications. 
     At block  242 , the method  230  determines whether the number of medications on the counting tray  106  matches the number of medications needed to fill the prescription. The pre-counter  34  may receive the prescription information or the label sheet information from the pharmacy management system  10 . The pre-counter  34  determines the number of medications needed to fill the prescription from the prescription information or the label sheet information. Particularly, the pharmacist may scan the information sheet generated by the pharmacy management system  10  using the bar code scanner  102 . The pharmacy management system  10  sends the information included on the information sheet to the pre-counter  34 . The electronic processor  14  of the pharmacy management system  10  communicates with the pre-counter  34  using the transceiver  22  and the communication network  46  to provide the information on the information sheet to the counter electronic processor  130 . The counter electronic processor  130  retrieves the information received from the pharmacy management system  10  based on scanning the bar code on the information sheet. The pre-counter  34  compares the number of medications on the counting tray  106  to the number of medications needed to fill the prescription. 
     When the number of medications on the counting tray  106  does not match the number of medications needed to fill the prescription, the pre-counter  34  instructs the user to add/remove a first number of medications from the counting tray  106 , at block  246 . The pre-counter  34  determines the difference between the number of medications on the counting tray  106  and the number of medications needed to fill the prescription and indicates to the user (e.g., using the display  114 ) to add or remove the first number of medications corresponding to the difference between the number of medications on the counting tray  106  and the number of medications needed to fill the prescription. For example, if 30 medications are needed to fill the prescription, but 32 medications are poured onto the counting tray  106 , the pre-counter  34  instructs the user to remove 2 pills and return the pills to the bulk container. Conversely, if 30 medications are needed to fill the prescription, but 28 medications are poured onto the counting tray  106 , the pre-counter  34  instructs the user to add 2 pills to the counting tray  106  from the bulk container. As described above, the method  230  then returns to block  242  to continuously determine the number of medications on the counting tray  106 . 
     When the number of medications on the counting tray  106  match the number of medications needed to fill the prescription, the pre-counter  34  indicates that the counting tray  106  includes the correct number of medications, at block  250 . The pre-counter  34  may also process the images captured to identify whether any medications are broken or whether the counting tray  106  includes any debris. The pre-counter  34  instructs the pharmacist to remove the broken medications or debris from the counting tray  106 . The pharmacist then empties the medications on the counting tray  106  into one of the cartridges  158 . The method  230  is repeated for each medication in the prescription to fill different ones of the cartridges  158 . This allows the pharmacist to fill the exact number of medications needed to fill the prescription into the cartridges  158  and does not need to dump excess medications from the cartridges  158  back into the bulk storage container after packaging. 
     In addition to counting the number of medications, the pre-counter  34  may also be used to determine one or more characteristics of the medications. For example, the pre-counter  34  may be used to determine the color and dimensions of the medications. The NDC information received from the NDC database  50  generally includes information regarding the color and size of the medications within set ranges. The pharmacy management system  10  communicates the color and size information with the automatic packager  38  for verification during dispensing and while packaging. However, there may be variations in the shade of the color (e.g., shade of blue) and size during manufacturing. For example, when manufacturing the medications, the medications do not always come out with the same color quality. A medication may be identified as blue in the database, but the shade of blue may be slightly different in the actual medication. Similarly, a medication may be identified in the database as having a diameter of 2 to 3 millimeters, and the actual size of the medication may be anywhere within that range. 
     As described above, the pre-counter  34  is used to capture an image of the medications in the IR/NIR, and visible light spectrum using the camera system  110  to determine one or more characteristics of the medications. For example, the counter electronic processor  130  activates the second light source  148  and captures an image of the counting tray  106  including the medications using the camera system  110 . The counter electronic processor  130  processes the image captured by the camera system  110  using known image processing techniques to determine the actual color (e.g., a particular shade of color) of the medications. Similarly, the counter electronic processor  130  processes the image captured by the camera system  110  to determine the actual size (e.g., a measured size) of the medications. The counter electronic processor  130  can determine if the actual color and actual size are within the ranges of expected color and expected size provided by the NDC database  50 . The pre-counter  34  correlates the color information and the size information with the identification information of the medication determined after scanning the barcode of the bulk storage container. The pre-counter  34  transmits the color information and the size information for each medication in the prescription to the automatic packager  38  and/or the pharmacy management system  10 . In some embodiments, the pre-counter  34  may only measure one characteristic (e.g., color or size) associated with each medication. In further embodiments, the pre-counter  34  may also or alternatively determine and compare other characteristics of the medications, such as weight (e.g., via a scale integrated into the counting tray  106 ), shape, and the like. 
       FIG. 12  depicts a method  254  for filling a prescription in a pharmacy. Although the method  254  includes specific blocks, all the blocks need not be performed or performed in the order presented. The pharmacy is an automated pharmacy including the pharmaceutical storage and retrieval system  30 , the pre-counter  34 , and the automatic packager  38  as described above. As noted above, the pharmaceutical storage and retrieval system  30  may be omitted. The method  254  leverages the automated nature of the pharmacy to verify the correct type and/or number of pharmaceuticals are loaded into each pouch as part of filling the prescription. In particular, the method  254  involves providing a triple verification system for a pharmacist to verify filling the prescription from when the prescription is received until the pharmaceuticals are loaded and sealed in a pouch to create a chain of custody for the pharmaceuticals. The chain of custody may be stored as an electronic file in the memory  18  of the pharmacy management system  10  or a remote computer or server. 
     At block  258 , the method  254  includes receiving, at the electronic processor  14 , a prescription to be filled by the pharmacy management system  10 . In one embodiment, the prescription may be received electronically through the communication network  46  from a healthcare facility. In other embodiments, the prescription may be received by scanning a paper prescription presented by a customer or by manually entering the contents of the prescription presented by the customer into the pharmacy management system  10 . 
     At block  262 , the method  254  includes generating, with the electronic processor  14 , an information sheet for filling the prescription. Generating the information sheet may include the pharmacy management system  10  electronically generating a list of medications (for example, including identifying information of the medications) provided in the prescription and transmitting the information sheet to the pharmaceutical storage and retrieval system  30 , the pre-counter  34 , and/or the automatic packager  38 . In other embodiments, the pharmacy management system  10  prints the information sheet using a pharmacy printer. The pharmacist may then physically carry the information sheet to be scanned by the pharmaceutical storage and retrieval system  30 , the pre-counter  34 , and/or the automatic packager  38 . 
     At block  266 , the method  254  includes retrieving bulk storage containers containing the medication needed to fill the prescription. As described above, the pharmaceutical storage and retrieval system  30  retrieves the containers including the medications for the prescription to be picked up by the pharmacist in response to receiving or scanning the information sheet at the pharmaceutical storage and retrieval system  30 . In other embodiments, the pharmacist may manually retrieve the containers including the medications from storage shelves of the pharmacy based on the information sheet. 
     At block  270 , the method  254  includes pre-counting, using the pre-counter  34 , the medications needed to fill the prescription. A method for pre-counting the medication is described above with respect to  FIG. 11 . At block  274 , the method  254  includes determining, using the pre-counter  34 , one or more characteristics of the medications needed to fill the prescription. The one or more characteristics may include a shape, dimensions, or color(s) of the medications. The one or more characteristics may be determined using the camera system  110  described above. At block  278 , the method  254  includes transmitting, using the pre-counter  34 , the one or more characteristics of the medications to the automatic packager  38 . The pre-counter  34  transmits the one or more characteristics to the automatic packager  38  over the communication network  46 . 
     At block  282 , the method  254  includes filling the cartridge  158  with the pre-counted medication. Once the required number of medications is placed on the counting tray  106 , the pharmacist fills a cartridge  158  by emptying the counting tray  106  into the cartridge  158  using the funnel  118  and the funnel gate  122 . At block  286 , the method  254  includes determining whether the prescription includes additional medications to be processed. The pre-counter  34  counts and determines the one or more characteristic for each type of medication needed to fill the prescription. When the pharmacy management system  10  determines that there are additional medications to be processed, the method  254  returns to block  270  to process the next medication in the prescription. When the pharmacy management system  10  determines that all the medications in the prescription are processed and filled into the cartridges  158 , the method proceeds to block  290 . 
     At block  290 , the method  254  includes verifying that the cartridges  158  are correctly filled. As described above, the pre-counter  34  provides the one or more characteristics of the medications to the pharmacy management system  10 . The pre-counter  34  may also provide identifying information along with an image (e.g., from the captured images) and a final count (e.g., before the counting tray  106  is emptied) of the medications to the pharmacy management system  10 . The pharmacy management system  10  receives the information from the pre-counter  34  and displays the information on a display of the pharmacy management system  10  for verification by the pharmacist. In one example, the pharmacy management system  10  compares the image of the medication received from the pre-counter  34  to an image available on, for example, the NDC database  50 . The pharmacy management system  10  may also display the image received from the pre-counter  34  side-by side with the image available on the NDC database  50  for verification by the pharmacist. The pharmacy management system  10  may indicate whether the correct medications were filled in the cartridges  158  to a user. The indication may include providing a colored border around an image of each medication. This provides an opportunity for the pharmacist to correct any errors prior to the medications being packaged. 
     At block  294 , the method  254  includes placing the cartridges  158  in the automatic packager  38 . The filled cartridges  158  are placed in cartridge slots  162  of the automatic packager  38  to begin packaging the medications. At block  298 , the method  254  further includes monitoring, using the automatic packager  38 , release of medications from the cartridges  158 . As described above, the automatic packager  38  includes sensors and cameras  168  in the cartridges  158  to count and capture images while the medications are being dispensed from the cartridges  158 . The automatic packager  38  may provide the count and the images to the pharmacy management system  10 . 
     At block  302 , the method  254  includes verifying, using the automatic packager  38 , that the correct medications are dispensed. The automatic packager  38  verifies that the correct medications are dispensed by comparing an image captured by the cameras  168  with the image of the medication received from the pre-counter  34 . The automatic packager  38  may provide the captured image and the image received from the pre-counter  34  for display at the pharmacy management system  10 . The automatic packager  38  may additionally provide an indication of whether the correct medications are dispensed by providing a colored border around the images as described above. This provides a second opportunity for the pharmacist to correct any errors prior to the medications being packaged. 
     At block  306 , the method  254  includes packaging the medications using the packaging unit  154  of the automatic packager  38 . As described above, the medications may be packaged into pouches or strip packages to be provided to a customer. At block  310 , the method  254  includes verifying that the correct number and/or type of medications were packaged into the pouches or strip packages. An example method of verifying the correct number and/or type of pharmaceuticals in a pouch or strip package is described in U.S. Patent Application Publication No. 2018/0091745, filed Sep. 27, 2016, entitled “VERIFICATION SYSTEM FOR A PHARMACY PACKAGING SYSTEM,” the entire contents of which are hereby incorporated by reference. In some embodiments, packaging includes sealing the medications in a pouch, a blister card, a vial, or other suitable packages. The automatic packager  38  uses the verification system  186  to capture images of the pouches. The automatic packager  38  verifies that the correct number and/or type of pharmaceuticals were packaged by comparing the image captured by the verification system  186  with the image of the medication received from the pre-counter  34 . The automatic packager  38  may provide the captured image and the image received from the pre-counter  34  for display at the pharmacy management system  10 . The automatic packager  38  may additionally provide an indication of whether the correct medications are packaged by providing a colored border around the images as described above. Accordingly, the method  254  provides a third opportunity for a pharmacist to correct any errors before providing the packaged medications to the customer. 
     One advantage of the above methods is that a pharmacist is provided with three opportunities to ensure the prescription is accurately filled. Additionally, the above methods leverage the automated pharmacy to efficiently package pharmaceuticals such that customer wait times are reduced. 
       FIG. 13  illustrates a pre-counter  314  for the automatic packager  38  according to another example embodiment. The pre-counter  314  is a medication counting device for use in retail pharmacies that detects and counts a number of medications that are placed on the pre-counter  314 . The pre-counter  314  displays the count and shares the count with other systems within the pharmacy. As illustrated in  FIG. 13 , the pre-counter  314  includes a counting tray  318 , a camera system  322 , a display  326 , a funnel  330 , and a cartridge slot  334 . 
     The camera system  322  includes a barcode scanner  102  (see  FIG. 6 ) and an imaging system for counting the medications on the counting tray  318 . The barcode scanner  102  is used to scan a barcode on a label of a bulk container retrieved from the device  54  or other location within the pharmacy and may be implemented similar to the barcode scanner  78 . The contents of the bulk container may then be placed on the counting tray  318  for counting by the pre-counter  314 . The counting tray  318  may be replaceable for cleaning and to inhibit cross-contamination between different types of medications. The counting tray  318  is pivotably attached to a housing of the pre-counter  314  such that a user can lift the counting tray  318  to direct the medications on the counting tray  318  into the funnel  330  without having to touch the medications. The funnel  330  is shaped to guide the medications from the counting tray  318  into the cartridge slot  334 . The cartridge slot  334  is provided below the funnel  330  to receive a cartridge  158 . In some embodiments, the pre-counter  314  may include a mechanism to rotate the wheel  860  or otherwise agitate the cartridge  158  to help make room for the pills to be funneled into the cartridge  158 . 
     The counting tray  318  may be transparent or translucent such that a lighting system  126  (see  FIG. 6 ) underneath the counting tray  318  can illuminate the contents of the counting tray  318 . Once illuminated, the camera system  322  may capture an image of the contents of the counting tray  318  to commence counting. The display  326  may be used to display the scanned barcode information and to display the count of the medications placed on the counting tray  318 . Based on the displayed information, a pharmacist or technician may add or remove medications from the counting tray  318  until the correct amount of medications is placed on the counting tray  318 . When the correct amount of medications is placed on the counting tray  318 , the user may transfer the contents of the counting tray  318  to the cartridge  158  ( FIG. 7 ) of the automatic packager  38  placed in the cartridge slot  334 . The user may transfer the contents of the counting tray  318  by lifting the counting tray  318  to guide the medications into the cartridge  158  through the funnel  330 . In some embodiments, a lockout mechanism may be provided for the counting tray  318 . The lockout mechanism of the counting tray  318  prevents the counting tray  318  from being lifted when an incorrect amount of medications are placed on the counting tray  318 . The lockout mechanism of the counting tray  318  may be unlocked when the correct amount of medications are placed on the counting tray  318 , such that the pharmacist may lift the counting tray  318  to transfer the medications to the cartridge  158 . 
       FIG. 14  is a flowchart illustrating one example method  338  of filling cartridges  158 . Although the method  338  includes specific blocks, all the blocks need not be performed or performed in the order presented. As illustrated in  FIG. 14 , the method  338  includes receiving, using the electronic processor  14 , prescription information (at block  342 ). Typically, a pharmacist examines a prescription presented by a patient to fill the prescription. The pharmacist may scan or manually enter the prescription information including dosage, quantity, and drug information through an input/output interface  26  of the pharmacy management system  10 . For example, the input/output interface  26  may include a scanner and/or a separate computer console to enter prescription information. 
     The method  338  also includes generating, using the electronic processor  14 , collection information based on the prescription information (at block  346 ). The electronic processor  14  receives the prescription information and generates collection information for a pharmacist to collect bulk containers including the medications listed on the prescription. The electronic processor  14  may use a look-up table to determine the location (for example, an aisle and/or bin number) of a medication listed on the prescription. The electronic processor  14  may then print or display the collection information listing the medications in the prescription and the location of the bulk containers including the medications. Additionally, in some embodiments, the collection information may also include an identification number of a cartridge  158  for each of the medications listed in the prescription. The pharmacist collects the bulk containers based on the collection information provided on, for example, a printed collection sheet. 
     The method  338  further includes pre-counting, using the pre-counter  314 , the medications needed to fill the prescription (at block  350 ). A method for pre-counting the medications is described above with respect to  FIG. 11 . The method  338  further includes identifying a cartridge  158  in which to fill the medications (at block  354 ). Either the pre-counter  314  or the electronic processor  14  may identify the cartridge  158  for filling. For example, as described above, the electronic processor  14  may identify the cartridge  158  on the collection sheet. The electronic processor  14  then transmits the identification information (e.g., an identification number) of the cartridge(s)  158  to the pre-counter  314 . The pre-counter  314  may identify the cartridge  158  based on the scanned bulk container. For example, when a bulk cartridge is scanned at the pre-counter  314 , the pre-counter  314  identifies a cartridge  158  compatible with the medication in the bulk container. Different cartridges  158  may be used to dispense medications of different sizes. Additionally, some cartridges  158  may be reserved for allergenic medications (e.g., penicillin) to reduce cross-contamination. The pre-counter  314  identifies the cartridge  158  compatible with the medications in the bulk container and displays identification information (e.g., a cartridge number) on the display  326  of the pre-counter  314 . 
     The method  338  includes reading, using the pre-counter  314 , an RFID tag of the cartridge  158  to receive identification information of the cartridge  158  (at block  358 ). Once the appropriate cartridge  158  is identified at block  354 , the pharmacist may grab the identified cartridge  158  and scan the RFID tag of the cartridge  158  at the pre-counter  314 . The method  338  further includes determining, using the pre-counter  314 , whether the correct cartridge  158  is read (at block  362 ). The pre-counter  314  compares the received identification information received from the RFID tag scan to the identification information of the correct cartridge  158  (e.g., the cartridge  158  identified by the electronic processor  14  or the pre-counter  314  at block  354 ) to determine whether the pharmacist grabbed the correct cartridge  158 . 
     In response to determining that an incorrect cartridge  158  is read at block  358 , the method  338  includes locking out the cartridge slot  334  of the pre-counter  314  (at block  366 ). The pre-counter  314  includes doors that may be locked out by a solenoid. When locked-out, the pharmacist cannot insert the cartridge  158  into the cartridge slot  162 . The pre-counter  314  locks out the cartridge slot  334  until the correct cartridge  158  is scanned at the pre-counter  314 . 
     In response to determining that the correct cartridge  158  is read at block  358 , the method  338  includes receiving, at the cartridge slot  334  of the pre-counter  314 , the correct cartridge  158  (at block  370 ). The method  338  then includes filling, using the pre-counter  314 , the cartridge  158  with the pre-counted medications (at block  374 ). In some embodiments, the chain of custody information is updated to include which cartridge  334  is positioned in the slot (e.g., via the RFID tag on the cartridge  334 ). Additionally, the type of the medications loaded into the cartridge and/or the number of medications loaded into the cartridge are also updated into the chain of custody information. 
     The method  338  further includes generating, using the automatic packager  38 , an indication for placement of filled cartridges  158  (at block  378 ). The automatic packager  38  may generate an indication using an indicator system of the automatic packager  38 . For example, when the prescription includes three different medications to be packaged, the automatic packager  38  may activate a blue LED of three cartridge slots  162  (also referred to as a cartridge mechanism) to indicate that the filled cartridges  158  should be placed in the activated cartridge slots  162 . The automatic packager  38  may activate the indicator system (e.g., an LED) of a first cartridge slot  162  to guide the pharmacist to place a first cartridge  158  at the first cartridge slot  162 . The automatic packager  38  may then activate the indicator system of a second cartridge slot  162  to guide the pharmacist to place the second cartridge  158  at the second cartridge slot  162  and so on. 
     The method  338  also includes determining, using the automatic packager  38 , whether the cartridges  158  are correctly placed on the automatic packager  38  (at block  382 ). The automatic packager  38  may read the RFID tag of the cartridge  158  using an RFID antenna at the cartridge slot  162  to determine whether the correct cartridge  158  is placed in the cartridge slot  162 . When a cartridge  158  is incorrectly placed on the cartridge slot  162 , the method  338  includes generating an indication that the cartridge  158  is incorrectly placed (at block  386 ). For example, as described above, the automatic packager  38  may activate the red LED of the indicator system  990  of the corresponding cartridge mechanism  845 . In some embodiments, the cartridge slot  162  may include a lockout mechanism (e.g., a solenoid lockout mechanism on a cartridge mechanism of the cartridge slot  162 ) that prevents an incorrect cartridge  158  from being loaded into the cartridge slot  162 . The automatic packager  38  may lockout the cartridge slot  162  until the correct cartridge  158  is placed in the cartridge slot  162 . In some embodiments, the lockout mechanism of the cartridge slot  162  may also prevent the cartridge  158  from being removed until the dispensing process is complete. 
     When the cartridges  158  are correctly placed on the automatic packager  38 , the method  338  includes dispensing, using the automatic packager  38 , the medications through the cartridges  158  (at block  390 ). In some embodiments, once the dispensing process is complete, the automatic packager  38  may indicate which cartridges  158  are ready to be removed. For example, as described above, the automatic packager  38  may activate the LEDs (e.g., a green LED) to indicate that the cartridges  158  are ready to be removed. 
       FIG. 15  is a flowchart illustrating one example method  450  of filling a prescription in a pharmacy. Although the method  450  includes specific blocks, all the blocks need not be performed or performed in the order presented. As illustrated in  FIG. 15 , the method  450  includes receiving, at the electronic processor  14  of the pharmacy management system  10 , a prescription to be filled by the pharmacy management system  10  (at block  454 ). As discussed above, a pharmacist examines a prescription presented by a patient to fill the prescription. The pharmacist may scan or manually enter the prescription information including dosage, quantity, and drug information through the input/output interface  26  of the pharmacy management system  10 . In some embodiments, the method  450  also includes generating, using the electronic processor  14 , an information sheet for filling the prescription. The information sheet lists the medications needed to fill the prescription. 
     The method  450  also includes identifying, at the pre-counter  314 , one or more bulk containers that contain medications to fill the prescription (at block  458 ). In some embodiments, the method  450  includes retrieving the one or more bulk storage containers containing the medications needed to fill the prescription. The pre-counter  314  associates the one or more cartridges  158  with one or more medications listed on the prescription. In some embodiments, identifying the one or more bulk containers that contain medications to fill the prescription includes scanning, using the pre-counter  314 , the one or more bulk containers identified at the pre-counter  314 . 
     The method  450  also includes counting, using the pre-counter  314 , medications from the one or more bulk containers to fill the prescription (at block  462 ). The pre-counter  314  prompts to add or remove medications from the pre-counter  314 . An example method of counting medications using the pre-counter  314  is described above with respect to  FIG. 11 . The method  450  also includes depositing the counted medications in one or more cartridges  158  (at block  466 ). Once the required number of medications is placed on the counting tray  318  of the pre-counter  314 , the pharmacist fills a cartridge  158 , for example, by emptying the counting tray  318  into the cartridge  158  using the funnel  118  and the funnel gate  122 . In some embodiments, the method  450  also includes determining an expected medication type to be counted using the pre-counter. When the medications on the pre-counter do not match the expected medication type, the pre-counter  314  prompts the user to remove medications from the pre-counter. 
     The method  450  also include placing the one or more cartridges  158  including the counted medications at the automatic packager  38  (at block  470 ). The filled cartridges  158  are placed in cartridge slots  162  of the automatic packager  38  to begin packaging the medications. As discussed above, the automatic packager  38  may generate an indication using an indicator system of the automatic packager  38 . For example, when the prescription includes three different medications to be packaged, the automatic packager  38  may activate a blue LED of three cartridge slots  162  (also referred to as a cartridge mechanism) to indicate that the filled cartridges  158  should be placed in the activated cartridge slots  162 . The automatic packager  38  may activate the indicator system (e.g., an LED) of a first cartridge slot  162  to guide the pharmacist to place a first cartridge  158  at the first cartridge slot  162 . The automatic packager  38  may then activate the indicator system of a second cartridge slot  162  to guide the pharmacist to place the second cartridge  158  at the second cartridge slot  162  and so on. 
     The method  450  also includes dispensing, using the automatic packager  38 , the medications in the one or more cartridges  158  (at block  474 ). Dispensing the medications includes singulating the medications in the one or more cartridges  158  for individually dispensing the medications. For example, a controller of the universal feed cassette  150 , or the packager electronic processor  202  controls each loaded cartridge  158  to individually dispense medications to the packaging unit  154 . The control signals are provided to the motor assembly to operate the motor  950 . As discussed above, when the motor  950  is driven, the shaft  955  rotates the wheel  860  to the individually dispense the medications  180 . The automatic packager  38  then verifies each medication as the medication is dispensed from the one or more cartridges  158 . 
     The method  450  also includes packaging, using the packaging unit  154  of the automatic packager  38 , medications dispensed from the one or more cartridges  158  into packages (at block  478 ). As described above, the medications may be packaged into pouches or strip packages to be provided to a customer. 
     The method  450  also includes verifying, using the automatic packager  38 , whether the medications are correctly packaged (at block  482 ). In some embodiments, the method  450  includes capturing, at the pre-counter  314 , an image of the medications for verification. The pre-counter  314  determines one or more characteristics of the medications listed on the prescription and transmits the one or more characteristics of the medications to the automatic packager  38 . The automatic packager  38  verifies that the correct medications are packaged by the packaging unit  154  based on the one or more characteristics of the medications received from the pre-counter  314 . In some embodiments, the automatic packager  38  captures a first image of the medications during singulation of the medications for a first verification. The automatic packager  38  also captures a second image of the medications during packaging of the medications dispensed from the one or more cartridges  158  into packages. Verifying whether the medications are correctly packaged may be based on the second image. 
     Various features and advantages of the invention are set forth in the following claims.