To enhance patient outcomes, look beyond the bottle to innovative compliance packaging

By: Daryl Madeira
Project Manager, Compliance Packaging
MeadWestvaco Healthcare Packaging

How do you increase the likelihood that a patient will have a positive experience with a prescription or OTC pharmaceutical product?

Innovative packaging has been shown to improve patient compliance and is fast becoming an integral part of product and marketing strategy. Compliance packaging –- packaging that helps a patient adhere to a medication regimen— is in a unique position to enhance the patient or consumer experience, as the package is a constant point of contact before medicine is taken.

Generally, a compliance package is a prepackaged, ready-to-dispense system that contains unit doses for one treatment cycle of medication, along with compliance aids and patient-education materials to help motivate and remind the patient to take the medication correctly. The successful compliance package should reflect thoughtful, innovative structural design and manufacturing practices, resulting in a final product that is aesthetically pleasing, safety-conscious and user-friendly—an ensemble that is advantageous to all parties.

Several factors are driving the growth of compliance packaging. An increasingly competitive environment has compelled manufacturers to look for more tools that support growth by promoting efficacy of use, product differentiation, and patient loyalty. The result has been a “win-win” for patients, the government, payers, and the pharmaceutical industry. In addition, important, rigorous child safety regulations are routinely enforced, and the ongoing development of child-resistant (CR) packaging is required.

The growing demographic of elderly represents a market segment that is most actively involved in drug therapy. This creates an enormous potential need for senior-friendly (SF) packaging that can assist people whose fingers may no longer be as strong and nimble as they once were and whose memories may be given to lapses.

Scope of the Problem
According to a recent survey conducted by the AARP, more than 75 percent of persons over 45 years old in the U.S. take, on average, four or more prescription medications daily. According to a study conducted by Health Ed, a U.S.-based marketing agency specializing in patient education, 50% of the time, patients are not fully aware of why they were given medication and they retain only 20 percent of what they hear in their doctor’s office. The American Medical Association reports that physicians failed to counsel their patients about prescriptions some 35 percent of the time. Because of all of the foregoing, patients—especially elderly patients—often neglect to take their medications at the recommended intervals and often do not renew their prescriptions on time or even at all.

The Economic Benefits of Compliance Packaging
Indeed, the economic benefits of compliance packaging are significant. According to a recent issue of Drug & Market Development, for example, 28 percent of U.S. hospitalizations, costing some $50 billion, are estimated to be a result of poor compliance with prescription medication instructions, while 17 percent of physician visits, costing an additional $10 billion, are due to drug-related problems.

How can compliance packaging help hold down these enormous costs? By increasing the likelihood that patients—especially elderly patients with chronic diseases —will follow the prescribed medication regimen, reducing the potential for poor health outcomes and higher healthcare costs.

Another study, conducted by Philip Schneider, M.D., a clinical professor of pharmacy at Ohio State University, examined the effects of packaging on a prescribed treatment regimen in elderly patients with hypertension. In the study, 88 adults over the age of 65 with high blood pressure received medication in solid oral dosage—48 in blister format, 40 in bottle format. The blister packs were a compliance design with a 28-day supply and included an indication for each day of the week, CR features, and special instructions. The results were remarkable. Patients given their medication in compliance packaging demonstrated a better than 20 percent improvement in getting prescriptions refilled on time and achieved a profound improvement in diastolic blood pressure over a 12-month period, compared with the control group given their medication in ordinary bottles. 6

Additionally, for each patient, the study indicated that bottle packaging was refilled two days later than compliance packaging, which adds up to one refill fewer per year. A 28-count package priced at $36.50, for example, for a patient population of 1,000,000 would translate into $36,500,000 in lost revenue per drug. Furthermore, the opportunity to repeat the efficacious outcome of the patients who used compliance packaging in people’s daily lives could help to significantly reduce healthcare costs.

Collaborating on Compliance Packaging
No one style of compliance packaging works for all medications. Packages must be developed on a case-by-case basis, and some of the more complex treatment regimens being developed by pharmaceutical manufacturers today require more innovative packages and design expertise. All, however, must make it easier for the patient to remember to take the proper dosage at the prescribed time and should take advantage of “billboard space” to communicate the brand message clearly and build brand equity.

MeadWestvaco Healthcare Packaging, a division of MeadWestvaco Corporation, is a fully integrated family of companies with a common history of award-winning design, structural inventiveness, and unsurpassed customer service. It has at its disposal one of the industry’s leading research programs, as well as a world-class, state-of-the-art packaging innovation center. The division services its global client base from operations in Europe and the U.S.

As a global leader in both paperboard and plastic healthcare packaging, MeadWestvaco Healthcare Packaging has developed a number of imaginative solutions combining various substrate materials, which can be customized to meet the needs of today’s pharmaceutical marketers. In addition, the company offers Kinexion™ Interactive Packaging, Centuria™ Brand and Supply Chain Security Solutions, and NatureSource™ Visual Packaging plastic cartons made from corn.

Innovative Compliance Solutions
A proven commercial success, Dosepak® features an outer carton for ample billboard space, a fold-over inner blister card, an attached insert for patient education and printed directions, and unit-dose packaging for improved patient compliance. It has proven effective in titration and combination therapy and can include a micro CD for patient-education materials or for information in a sample or trade package. Dosepak carries the highest possible child-resistance rating (F=1), and outside testing has proven it to be very senior-friendly.

Dosepak has received a number of industry awards, including the Healthcare Compliance Packaging Council’s (HCPC) 2000 Compliance Package of the Year Award, the Institute of Packaging Professionals (IOPP) 2003 AmeriStar Award for the pharmaceutical category, the IOPP
2003 Best of Show Award for Procter & Gamble’s Actonel 35mg Dosepak, and the 2003 WorldStar Award.

One of MeadWestvaco Healthcare Packaging’s simplest designs is the Perfpak®, a wallet-style multicavity blister pack with a fold-over paperboard flap covering individual doses calendarized to
days of the week or dates of the month. Inexpensive and convenient, it offers ample space for conveying instructions as well as promotional materials. Very senior-friendly, it has an intermediate child protection rating of F=3.

Shellpak™ is a first-of-its-kind molded plastic blister package with a patent-protected design.

The rigid plastic “shell” construction is senior-friendly, has an F=1 child resistance rating and is especially well suited for friable tablets. The package has been designed for in-house fulfillment using standard high speed cartoning equipment. Shellpak can be configured in a wide variety of sizes, shapes and colors to reflect brand image and provide differentiation for the product it transports, opening up unprecedented opportunities for marketing and branding efforts.

Starterpak™ is intended for physician samples or OTC markets where patient compliance is still important, but the rigors of CR and regimen size are not as demanding—though CR requirements can be accommodated as necessary. Starterpak’s unique blister pack design incorporates MeadWestvaco Healthcare Packaging’s ConnectedBranding™ feature. With ConnectedBranding, the inner card is captive to the outer carton for the life of the product, keeping directions intact, promoting adherence to therapy, and improving brand equity. Dosepak and Shellpak also incorporate the value-added ConnectedBranding™ concept.

Looking Ahead
Intelligent packaging that educates and interacts with patients and consumers will play a crucial role in healthcare product development and marketing. MeadWestvaco Healthcare Packaging, building on the Dosepak design, today offers Cerepak™ electronic compliance packages that record the date and time each tablet or pill is removed from the package. This data can be quickly and easily downloaded into a computer for analysis by the patient, the healthcare provider, or a clinical trial organization.

The system also enables interaction with the patient, the recording of side effects or symptoms, and the discreet prompting of the patient, via light, sound, or vibration, to remind the individual to take the medication. Technology currently under development can even allow a package to activate a cell phone or send a message to a PDA.

As a world leader in packaging designed to increase both compliance and adherence, MeadWestvaco Healthcare Packaging offers creative, proactive compliance packaging solutions that can help make a positive difference in the lives of millions of people and, consequently the bottom line. That’s a regimen worth sticking to!