Fill the Void

Innovators love a void. And one of the biggest voids in healthcare packaging is the fact that most manufacturers do not provide pharmaceuticals to U.S. pharmacies in unit-of-use packs, let alone unit dose, unless the regimen specifically demands it, like those for respiratory drugs or hormone treatment. In the words of one pharmaceutical manufacturer, providing all pharmaceuticals in unit-of-use packaging is just not cost-effective.

Regimen packaging is therefore left up to the pharmacies, despite reports that the standard pharmacy vial does little to encourage patients to adhere to their prescribed regimens. In fact, the Healthcare Compliance Packaging Council (HCPC) blames noncompliance for the deaths of more than 125,000 Americans annually. And pharmacists, who may be able to encourage compliance through counseling, are in short supply. They have little time to spend with patients, probably because they are too busy counting out tablets.

While manufacturers offer few solutions, some entrepreneurs are, thus filling the void. But will their efforts be enough?

For instance, TabSafe Medical offers a unit about the size of a coffee maker for holding a month's supply of up to nine different prescription medications. According to Ginger Gibbs, vice president of business development for Aircom Manufacturing (Indianapolis), which makes the TabSafe units, "each pill is released only at its proper time, and the unit alerts the patient to take medicine by beeping and a flashing light. If the pill is not taken, a caregiver will be notified by pager." The system can also be programmed to alert patients to take medications that cannot be loaded into the unit, such as an insulin shot.

Two alarmed closures, the Pill Timer from Med Time Technology Inc. (Boca Raton, FL) and the Smart Cap from Pharmaceutical Direct Inc. (Dover, NJ), debuted this year. The Pill Timer beeps when the next dose is due, automatically resetting itself after it is closed. The built-in timer in Smart Cap resets itself when the cap is closed, keeping track of when the bottle was opened last.

Medicine-On-Time (Baltimore) and Assisted Self-Medication Enterprises Inc., through its subsidiary Mediclock (Chula Vista, CA), both offer automated systems for pharmacists to repackage prescriptions into unit-of-use packaging. Medicine-On-Time's system allows pharmacists to sort, package, and label multiple prescriptions for one patient into one dosage cup. The cups are marked with the patient's name, contents, and prescribed time, and they can hold up to six tablets. McKesson Pharmacy Systems adopted the system earlier this year. Mediclock offers an automated repackaging system for pharmacists to place tablets into disposable cassettes. The cassettes can then be loaded into a Mediclock dispenser for use at home.

Despite their creativity and their practicality, however, these solutions probably won't be able to make a sizable dent into noncompliance statistics. They will help some patients adhere to regimens, mainly those patients or caregivers who recognize that they are missing or doubling up on doses. But the masses of generally healthy patients whose chronic conditions haven't yet become critical, and therefore a missed dose has caused little or no trouble, still need encouragement.

Instead, manufacturers need to provide universal unit-dose packaging that prompts regimen compliance to keep those conditions in check. Such packaging may not be cost-effective for them, but a pharmaceutical regimen is much more cost-effective than the $100 billion that HCPC estimates is spent on noncompliance every year.

Daphne Allen, Editor

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