Modular logistics: how to keep medications from getting lost on the way

During 2025, the medications bought directly by Italian public hospitals cost €15.9 billion. The plan was 11.2 billion. The gap against the legal ceiling is 4.7 billion. In the same year, spending on medicines dispensed by contracted pharmacies stayed under its own ceiling (AIFA, pharmaceutical spending monitoring, January–December 2025, published 9 June 2026). The hospital channel is the one under most pressure.

That gap does not come from logistics: it comes mostly from high-cost medications. But the hospital is the channel where every avoidable penny shows up most clearly.

It is also the channel where hospitals have started to buy something different. In the logistics contracts signed with public facilities over the last two years, modular logistics went from a historical 8% of the total to 18% (Osservatorio Contract Logistics “Gino Marchet”, Politecnico di Milano, 2025 edition).

Those contracts do not buy furniture and drawers. They buy logistics services, and they change what the hospital asks for in the first place. If you choose modular logistics, you have to describe how material moves through the building: how many times it changes container, who handles it, where it loses its label. Tenders are following this shift.

So what is bought is not just furniture. It is a flow that the hospital pays for over years. It pays in staff time and in material that expires before anyone uses it. Those costs are not in the quote, and they are worth looking at before signing.

Here we set out the criteria that get the medication to the right bed, at the right time, without losing it on the way.

Standard sizes and modularity: why the cost goes down over the years

For the purchasing department, what counts is not the list price. It is what the system costs over the years. Modularity works here in two ways.
First: few drawer sizes, two widths, make the handling the same in every ward, so nobody has to learn a different system floor by floor.
Second, and this matters more: the same drawer moves often between warehouse and ward, so the ward does not build a second warehouse of its own. That is where duplicate stock and expiry dates come from.

Then there is the difference between a system you can extend and one you have to rebuild. If a ward changes purpose, doubles its beds or takes a different kind of patient, a modular system works with the accessories the manufacturer already sells. A rigid system has to be redone every time the ward changes.

Two things to put in the tender:

1. a system that can be extended and rearranged with the manufacturer’s own accessories, without replacing the whole system
2. a drawer that moves often between warehouse and ward, so the ward does not have to build its own store and end up with duplicate stock.

A way to work out the return on the investment during a tender

The figures that circulate in the sector (“you save X euros per bed”, “the investment pays for itself in Y months”) are almost always estimates. The method behind them is almost never published, so treat them with care.

The return on a modular system rests on three items a hospital can measure on its own data:

1. the cost of the material that today expires or goes missing between the pharmacy, the transport to the ward and the cart at the bedside
2. the staff time spent repacking, searching and reordering on an intuition
3. the cost of duplicate stock, kept because nobody knows for sure how much is already there

Those three items go against the cost of the modular system and the time it saves. It is a calculation each hospital does on its own volumes. It is not a figure to take on trust.

The return is best worked out together with the supplier: on which data, with which method, and checked on one pilot ward before it is rolled out across the hospital.

Two approaches side by side

There are two ways to move material, and they differ on five concrete points. None of the five appears in the quote.

1. The first is the number of repackings between warehouse and bed: many if the material changes drawer at every stage, none if it stays in the same drawer the whole way.
2. The second is the number of different formats to handle: many if every stage uses its own container, few if you work with drawers in only two sizes. Cutting the number of medication codes is a different job, and it means reviewing the whole system.
3. The third is restocking: it is always recorded, on paper or digitally, but it gets much faster when a drawer with an identification system, in see-through plastic, shows at a glance what is missing.
4. The fourth is a ward changing purpose or size: a rigid system has to be replaced, a modular one is extended.
5. The fifth is the label: in the first model it has to be redone every time the drawer changes, in the second it stays on the same drawer the whole way.

These five differences show up in daily use, not at the moment of purchase. If the tender does not cover them, the costs will come as a surprise.

Frequently asked questions

What is integrated hospital logistics?
It is managing the flow of clinical material (medications, supplies and devices) as one continuous path from the warehouse to the patient’s bed. Drawers, transport equipment and ward furniture fit each other, so nothing has to be moved from one container to another. It is the modularity of the drawer that makes this flow work in practice.

Why do medications expire in the ward?
There are many reasons. Part of it comes from how the flow is built: material moved between different containers, restocking done on a hunch without seeing the real stock, each ward organized its own way. A standard drawer works on those points. It does not work on expiry dates that depend on how much a ward uses or on how much was bought.

What does the standard size mean in a tender?
It means the drawers have the same dimensions as those in the pharmacy, and they fit the transport equipment and the ward carts without adapters. It is the condition for one container to travel the whole path.

How do you work out the return on an integrated logistics system?
You compare, on your own volumes, what expired medicines, staff time and duplicate stock cost you today against the cost of the standardized system.