Lobbying for Blisters
By Marie Redding
Blister use is on the rise, suppliers say. “Orders have been strong—our business has been growing every year,” says Ben Brower, vice president and sales director, Pharmaworks (www.pharmaworks.com).
One area where use is not increasing, however, is sampling programs. New drug launches were once a heavy growth area for blister packs, but not anymore. Drug patents are expiring for many companies, and the approval process for new drugs has been slow, suppliers say.
“Physician sampling programs have decreased significantly in the past 10 years, due to the fact that very few new drugs have been launching,” says Frederick J. Lutz, director of sales and service, Constantia Hueck Foils (www.constantia-hueck.com).
Despite this, some say that of the number of new drugs launching, they’re seeing a larger percentage go into blisters, rather than bottles. “Many customers are conducting stability tests of new products in blister material—products that were initially intended to launch bottles,” says Ward Smith, director of marketing, Keystone Folding Box Co. (www.keyboxco.com/).
Many are crediting Walmart—and its use of MeadWestVaco’s (www.meadwestvaco.com) Shellpak, a calendar blister package—for a recent spike in blister use. “Walmart is at the forefront of the move toward blisters,” says Dirk Corsten, managing director, Uhlmann Packaging Systems (www.uhlmannpackaging.com). “The retailer moved toward using more blisters during the past 3 to 4 years, and they are gradually increasing the number of drugs being delivered that way.”
Brower agrees. “The fact that Walmart is now giving blisters over the pharmacy counter for its 30-day regimen is something we wouldn’t have seen 10 years ago. Walmart broke the grid with this, and now other companies are following,” he explains.
Lutz feels that patient compliance is quickly becoming the area of highest growth potential for blisters.
Adds Brower: “We’re just starting to hear more companies ask how they can package drugs more effectively.”
Big Changes Ahead?
The calendarized pack has been helping women take oral contraceptives properly for years, yet it still hasn’t influenced the packaging of most other types of drugs—yet. Some say due to recent studies, we may see change.
Smith points to two recent studies published earlier this year. One showed how calendar blister packaging—specifically Walmart’s use of Shellpak by MeadWestVaco—affected prescription refill adherence. The second was conducted by Catalent Pharma Solutions (www.catalent.com), with SDI (a provider of anonymous patient-based prescription data). Both studies show that blisters do influence a patient’s compliance with drug regimens, for the better.
“These studies show that prescription medication in calendarized blister packs—adherence packaging—improves adherence at statistically significant levels,” says Smith. “It’s meaningful to the packaging industry because it supports what many of us have been saying for years regarding the benefits of compliance packaging—and now these data spell it out.”
Some suppliers agree with Smith, but others feel differently.
“The fact that blisters offer better patient compliance has already been proven, so it’s not news,” says Lutz.
Corsten agrees. “A number of studies have already shown that blisters are a better way of administering drugs. We’ve known this for years,” he says.
Recent studies report the same conclusion as did an older Ohio State University study, which is widely known throughout the industry. However, Smith says that due to the smaller scale of the OSU study, some in the industry often discredit it.
Smith also says he’s seen customers waiver on whether or not to use calendarized blisters due to the lack of published data that prove benefits. “These are challenging economic times for most companies right now, including pharmaceutical manufacturers. It may take the hard facts reported in these studies to justify the incremental cost of using adherence packaging,” says Smith. “With the collective data now available, more companies are—and will—show an interest in adherence packaging.”
Still, others aren’t so optimistic. “I don’t expect to see any type of impact due to these studies,” says Tim Brickle, president, Ruspak. “As suppliers, we’re obviously hoping more companies will go with blisters, but I haven’t seen any signs of change. Many pharma companies will be slow to change unless there’s a definite financial advantage for them to do so,” he says.
Lutz agrees, saying, “I wouldn’t make any predictions about these new results having any effect on the industry, anytime soon.”
Despite other opinions, Smith still feels strongly that the new data can’t be ignored for long. “The results are in sync with the message that adherence packaging offers the opportunity for better patient compliance with a daily dosing regimen, which positively impacts patients’ health. This is real news,” Smith says.
Smith also says its good news for the pharmaceutical industry. “It shows that a package change from bottle to blister can potentially improve both patients’ health and a product’s sales,” he adds.
Bottles Still Rule
In light of all the benefits, why aren’t we packaging more drugs in blisters?
“Blisters are used almost exclusively in other parts of the world,” says Corsten.
Illustrating global preferences, Douglas Voreis, vice president, Perlen Packaging (www.perlenpackaging.com) guesses that approximately 80% of all drugs are in bottles and 20% in blisters in the United States. “Those percentages are almost exactly reversed in the rest of the world,” he says.
Lutz says that American consumers don’t like blisters because they can be difficult to open, and Corsten agrees. “The amber-colored vial was introduced in 1957, and it’s the way America likes to take meds,” says Corsten. “But hopefully this will change in the near future.”
There are also packaging line and economic issues to consider. “If more blisters were chosen over bottles, the whole packaging operation would need to grow significantly, for pharma manufacturers,” says Corsten.
Voreis says that the existing packaging infrastructure in the United States is probably a major reason for low blister-to-bottle percentages. “Pharma companies have a lot of dollars and technical knowledge tied up in their bottle lines and they are reluctant to replace them with new blister lines if they don’t have to,” he adds.
Even if the industry agrees a blister’s benefits are becoming too numerous to ignore, suppliers say it will take a catalyst to inspire any major increase in blister use.
Corsten points out that retailers could be an influential force by pressuring drug companies to use more blisters. “There are many benefits for retailers, such as a decrease in the number of pharmacists needed to dispense medication if it were in blisters, and reducing inventory,” he says.
Suppliers say insurance providers could act as the catalyst to spark the demand, since patients with chronic illnesses have the most to gain from calendar blister packs.
“If managed healthcare puts pressure on pharma companies to switch to calendarized blister packs, they will,” says Lutz. “They should realize that using blisters could lead to a significant savings, when taking meds properly keeps patients healthier—and out of the hospital.”
Corsten agrees. “Health insurance providers are looking into the benefits of blisters, including how they contribute to better health—and exactly how much it can save them on healthcare costs. They can definitely pressure drug companies by lobbying for new legislation,” he says. “Whether or not they will, remains to be seen.”
Lutz isn’t bracing for huge changes in blister use just yet. “Nothing of significance will happen unless there’s a catalyst—a big push by either retailers or managed healthcare.”
Is the personalized blister—one that contains a week’s worth of different meds for one patient—the next type of package? The idea has been buzzing around for a while now, some suppliers say.
“It’s already out there, in low volumes,” says Brower. He says some pharmacists are creating personalized blisters for nursing homes using a tabletop machine to seal multipill packs.
“Establishing clarity and transparency with respect to medication that is required daily is a key challenge for the pharmaceutical industry,” says Thomas Groezinger, managing director, AvidiaMed, a part of Körber Medipak. “And this is precisely where we address the problem with our new product, the MediFalter.”
AvidiaMed addresses the compliance issue by personalizing a blister for patients. Its new customized patient blister for the German market, MediFalter (“Falter” is the German word for “folder” and a species of butterfly), contains different types of tablets sorted for the week, on one blister with precise dosage instructions.
“We can eliminate up to 20 bottles of pills with one customized blister, designed in personal dosages for the entire week,” says Groezinger. The MediFalter, produced in a fully automatic production process with a “zero error tolerance” as a standard specification, is being used in some parts of Germany now, while the concept is being tested.
Perlen Packaging supplies the blister films for some multipill pack forms sent to nursing homes. “One blister contains all the meds for a patient for a week, or a month,” says Voreis.
Brower says Pharmaworks has been experimenting, too, since some of its customers have been asking the supplier to help develop a feasible process to make the personalized blister a reality for the mainstream market.
Challenges still exist, however. It could be cost-prohibitive given production line size and the need for precise methods to track the prescription through the process, according to Brower. Quality control systems are also needed to verify that the prescription is correct without a pharmacist having to check the contents of each blister. “And, it’s further complicated by the amount of drugs that would be needed on or near the packaging line,” Brower explains.
Brower does see this idea coming down the pipeline—however long it takes.
Brower says that retailers, rather than drug manufacturers, may be the first to “test the waters” with a personalized blister concept. “Retailers may first find out whether or not the average person recognizes the benefit of this type of blister. They wouldn’t commit to buying large-scale equipment to produce it automatically until there’s a demand. And in this economy, it may take years,” Brower says.
Could it be two, five, or 10 years down the road?
“No one has a good answer for that,” says Brower.