In its "Finding the Right Pharmacy" survey report, Consumer Reports suggests that one reason for consumers to switch pharmacies is to seek out individualized services, such as offering pills in convenient blister packs. The packaging of any retail product can affect how the product is used by consumers, but prescription packaging can also impact health and safety. Reducing administration error is the oft-stated goal, and unit dose packaging is generally employed in institutional settings. But the personalization that comes with single-dose medication packaging may turn out to be the most compelling for patients.
In addition to error reduction, there is evidence that singly packaged medications can improve adherence, especially with elderly patients. But adherence is not the only innovation driver for packaging manufacturers.
Other features that drive pharmacy investments include:
- Machine Efficiency: doses per minute
- Usability: patient and pharmacist/pharmacy tech usability
- Cost: cost per dose, including consumables, usually gained by procuring in bulk and repackaging in-house
- Integration: packaging integration with CPOE [Computerized Physician Order Entry], workflow, inventory management and billing software
- Safety and Compliance: patient safety and compliance with FDA and FTC regulations
- Tracking and Identification: increased use of RFID [radio frequency identification] and QR [quick response] codes
- Multi and Unit Dose Flexibility: some devices can perform both unit and multi-dose packaging.
Unit dose packaging extends beyond pills and vials. Little Rock, Ark based Advanced Tissue offers unit dose packaging for dressing changes as part of self-managed wound care. Unither Pharmaceuticals produces sterile unit dosage forms using a Blow-Fill-Seal approach as well as Unistick liquid stick packs.
Unit dose packaging offers the promise of tailoring packaging to the special needs of each patient. While there are universal needs -- to identify the correct dose at the correct time - some patients have additional requirements. Patients with macular degeneration may have trouble reading labels. Patients with arthritis may have trouble opening the packaging. The solution chosen at Jeffrey's Drugstore in Canonsburg Pennsylvania is the "Dispill" dosing system, which prints the patient's name and recommended administration time for each dose, e.g., "Jones, Edward I Feb-19 I Wed Bedtime." Dispill multi-dose packs are mounted in detachable, individual blister packs. Other pharmacies that offer Dispill include Lakemont Pharmacy in Bellevue, Wash., and Oval Pharmacy in New York.
Synergy Medical (SynMed) supports both multi-dose and unit-dose formats, flexibility that owners of the family-owned Fox Drug Store in Selma, Calif, sought in their machines.
That flexibility is featured in the AmerisourceBergen Automed Faspak EXP, which allows pharmacies to switch between standard width for traditional unit dose and multi-dose packaging and narrow width for automated dispensing cabinet replenishment.
Size matters, too. Apace, another unit dose blister pack manufacturer, says its packaging is effective for large and difficult to package meds. Apace is also serialization ready.
Omni-Packaging at Omnicell
Omnicell owns multiple product lines and subsidiaries in the medication packaging space.
Omnicell MTS offers heat seal and cold seal blister cards suitable for single dose packaging. MTS Unit Dose systems include low volume alternatives (AutoGen, Autobond, Gemini), or higher volume PrePack MTS-350 and OnDemand automation systems. The OnDemand AccuFlex solution is notable for software that provides flexible, patient-specific personalization of packaging. For patients with more complex multimedication regimens, MTS offers Omnicell's SureMed adherence blister cards to organize meds.
In 2015, Omnicell acquired Aesynt, whose PROmanager-Rx is a compact barcode-driven robotics system that can automate oral-solid unit doses.
Pouches and Canisters
Rx:Safe's newly introduced Rx:ASP 1000 uses a pouch printing method, which reduces consumables costs by automatically creating a pouch that exactly fits the contents without requiring machine reconfiguration. The company also manufactures the Rx:ASP 20, an entry level packaging solution for smaller operations.
The BD Rowa Dose system follows a modular design which makes it suitable for unit, multi and combined doses. Rowa Dose allows pharmacies to dispense from up to 700 canisters that are identified by RFID, but can also accommodate special shapes, such as for split medications when
configured to use a pouch packaging process.
For patients not comfortable with that approach, PillPack, a full service pharmacy based in the Northeast, attempts to improve medication adherence by sending patient prescriptions already organized in individual dose packs rather than individual pill bottles. The service is already available in 47 states.
Unit Dose Strategy
Pharmacies which have not already done so should develop a unit dose packaging strategy, say Alison Kagel and Gary Reckart, who work in a 24/7 Florida pharmacy. That strategy must take into account pharmacy workflow, usually managed through bar codes, and shifts in packaging technology.
Manufacturers Have Responded.
Last year tech provider Innovation introduced the PharmASSIST CoBot, which the developer characterizes as "a unit dose system on steroids." It can be configured to fit into multiple workflows.
Medical Packaging, maker of Auto-Print Oral Solid and Fluidose Oral Liquid unit dose systems, also provides a label printer and Pak-EDGE UD bar code software to expedite workflow integration.
Organizations unprepared to venture into in-house packaging automation can utilize third party services, such as those offered by Safecor Health. Pharmacies should expect increased consumer awareness of packaging alternatives- some of it self-service: in addition to reaching out to
pharmacists and health systems, Dispill's own web portal invites "Medicine Takers" to contact the firm directly- a potential disruptor. Chudy Group (TCGRx)'s CEO Duane Chudy believes that printing a patient's image on packaging can be beneficial, suggesting that still more packaging personalization is yet to come.