After much thinking, I've narrowed down the dispensing mechanism to 2 ideas - a rotating plate (with holes) and a tube with plate.
The rotating plate is easy to load (just dump in the pills), but it unfortunately takes up a lot of space. The tube is very compact, but it is hard to load.
I looked at some other methods, such as a shaker plate or a conveyor, but these were eliminated because of size/noise/impracticality.
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Rotating disc works well, but usually has to be done with suction.
Tube with disc sort of dispensing has the drawback of being hugely sensitive to pill sizes. How do you adjust it so that you don't give several tiny pills or break pills in half? How do you verify that they were actually dispensed?
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We had planned on using optical gates, but unfortunately, we ruled our such a "universal" solution as being too complex and costing too much. Also, the system NEEDS TO dispense reliably, because the consequences of missing a dose can be very bad.
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