Progress of Compliance Designs Discussed at HCPC Event


Hard-to-open packages as well as the cost of the formats can be hurdles to adopting compliance systems. However, compliance packaging is gaining momentum, participants said at the Healthcare Compliance Packaging Council’s 16th Annual Symposium on Patient Compliance in New Brunswick, NJ. The general consensus at the event seemed to be that unit-of-use is the wave of the future.

Schering-Plough has put a process in place for developing “patient-centric” packaging. Packaging for new products in development for each drug class will be evaluated, reported Jennifer Johns, a manager in Schering-Plough’s package development group.

“Compliance is a big issue for us. [The group will examine] compliance and how to minimize patient confusion in using the drug. We are looking at blisters and bottles, with supporting global professional research.” The process will also encompass brand identity issues in some cases, Johns said.

Eli Lilly has “a broad program” in place for addressing “not just packaging, but patient needs in general. We are [also] focusing on consumer complaints [in the area of] medical devices,” said David Furusho, manager of quality assurance, PSR&D, Eli Lilly & Co.

John Bitner, director of packaging development, Watson Pharmaceuticals, said that generic packaging has improved to support patient use issues, but generic pricing can’t support high packaging costs. “We say ‘differentiated’ rather than ‘innovative’ to indicate that we are differentiating with a purpose, and not running up the cost,” said Bitner.

“Our clients demand that we control our costs. We have a profit margin to work with. Packaging has to be a shared expense,” he added.

“We will be challenged by compliance packaging. But the door has been opened. The pharmaceutical industry will go to unit-of-use one way or another, whether with bottles or blisters,” Bitner said.

A Medication Adherence Task Force at Walgreens focuses on pharmacists’ interaction with patients for promoting adherence. Pharmacists employ “motivational interviewing” techniques to encourage patients to communicate in their own words their concerns and plans, said Steve Basiago. The founder of RxAdherence, Basiago heads the Task Force at Walgreens Health Services. “This is a proof of concept that uses more interactive techniques with a foundation in behavioral psychology to counsel patients,” Basiago said.

Pharmacists are employing the face-to-face intervention program in an 80-store pilot. They address prevention by discussing the goals of therapy and creating a value proposition in patients’ minds. The pharmacist makes sure the patient has a plan for keeping to the regimen.

In then monitoring patients’ progress, pharmacists might recommend practical solutions, or coach patients to increase their motivation, after refill frequency monitoring identifies non-adherence. “We have a technology platform that tells the pharmacist what the intervention should be so we have consistency between patients. We are measuring the program’s benefits [and will be looking for] “statistically significant results,” he said.

Basiago noted that 20% of patients don’t submit their prescriptions to the pharmacy. “A lot of [compliance issues] are cost-benefit related. Patients have to be confident and committed that they understand the regimen and can deal with it,” he said.

“ ‘I forgot’ is big reason for not taking medication, Basiago noted.

The program provides an opportunity for the patient to reveal to the pharmacists the underlying reasons for “forgetting.” As an aid to adherence, packaging helps the patient to remember. “As a pharmacist, I think it would be ideal if all medications came in unit-dose packaging,” Basiago said.

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