5.19.20 - The ScriptDrop Team Taking the Pulse: Multi-Dose Adherence Packaging

The coronavirus pandemic has interrupted lives all over the globe. Schedules have been thrown out of the window. As sleep and mealtimes shift from day to day, it can be difficult to remember to take daily prescriptions. 

That’s a problem. Many daily medications are maintenance medications for chronic conditions, meaning they control symptoms or keep the condition in remission. Failing to take a maintenance medication can cause a relapse and worsening of symptoms. In fact, poor adherence to therapy causes at least 100,000 preventable deaths and billions of dollars in medical costs every year. 

What is adherence?

When a patient “adheres” to therapy, it means they take their medication exactly as prescribed. They take the right dose at the right time in the right way. This isn’t as easy as it sounds, of course. Even the most careful person could miss a dose or misunderstand their doctor and take a medication incorrectly. 

To improve adherence, patients can take a few simple actions. 

  • Ask questions. When a doctor prescribes a new medication, patients should ask what it does, how it should be taken, how long it will take to see results, and what sort of side effects they may experience. They can also talk to their pharmacist for guidance.
  • Try home delivery. For patients living with chronic illness or disability, just going to the pharmacy can be a major obstacle. Busy parents and caregivers struggle with pharmacy runs as well. Luckily, many pharmacies offer home delivery – and patients can request delivery from any pharmacy through ScriptDrop. 
  • Create reminders. Patients who take a large number of medications at multiple times can benefit from reminders. For home-bound patients, this could take the form of a paper checklist, strategic sticky notes, or an alarm clock. For patients on the go, digital reminders set on a cellphone or smart watch are a better choice. 
  • Consider multi-dose adherence packaging. While some patients may be comfortable using a pillbox to organize their medications, special adherence packaging can help patients take their medications at the right time of day and avoid missing doses. 

What is multi-dose adherence packaging?

Adherence packaging is typically used for solid, oral medications like tablets and capsules. It comes in two forms: 

  • Blister packaging: doses of medication are placed in a sheet of plastic bubbles or cups sealed with plastic, paper, or foil. 
  • Pouch packaging: doses of medication are sealed in small plastic pouches, which are connected in a long strip. 

Adherence packaging for single doses isn’t new. It first appeared in the early 1960s. As oral contraceptives became popular, several drug manufacturers developed blister packaging with a “calendar” element to help patients remember to take their contraceptive every day.

But most patients take more than one medication per day. As of 2014, 60% of Americans suffered from at least one chronic condition. Chronic-disease patients tend to take multiple maintenance medications, and may also take daily vitamins and supplements. Older adults also take more prescription medications overall. As the Baby Boomer generation ages, the proportion of Americans with multiple daily prescriptions will only increase. 

So it’s no wonder that multi-dose adherence packaging has become a big deal. Instead of receiving pill bottles or boxes of blister-packed tablets from the pharmacy and sorting them into a pillbox, patients receive all of their medications packaged together. 

The patient’s prescriptions are organized by time of day and dose in a perforated blister pack sheet or in a perforated strip of pouches. In some cases this is done manually by a pharmacist. In other cases, special computerized machinery automatically sorts and seals the medications. Either way, the sorted medications are checked by a pharmacist for accuracy. 

To take their medications, the patient just needs to tear off the appropriate pack or pouch for that day and time. All of their pills – including over-the-counter vitamins, supplements, or NSAIDs – are already sorted for them. 

Which patients benefit from multi-dose packaging? 

Generally, multi-dose packaging is best for patients who take several medications multiple times a day. It’s good for older adults who may lack the dexterity or vision to sort small pills into a pillbox (though some hand dexterity is still needed to tear open the pouch or remove the seal on a blister). 

It’s also useful for caregivers. In fact, multi-dose packaging is used extensively in nursing homes and other long-term care facilities to ensure residents get their medications at the right time. 

Blister packs and pouches aren’t perfect, though. Patients who take very large oral medications or many pills at a single time may not benefit. The largest blister sheets can hold no more than 10 average-sized medications per section. Pouches only hold between 5 and 10. Since many vitamins and other supplements are quite large, OTC items can quickly take up the available space. 

In that case, patients may receive multiple blister packs or pouches for a certain time of day. While grabbing one packet for a Monday morning dose is convenient, remembering to grab four packets from four different pouch-strips could lead to serious mistakes. 

Patients with prescriptions that are not solid oral medications won’t see much benefit from multi-dose adherence packaging, either. Patients will still need to create their own system to stay adherent to any liquids, inhalers, injections, gels, suppositories, and the like. 

Where is multi-dose adherence packaging available?

While Amazon’s PillPack is the poster child for multi-dose adherence packaging, blister packs and pouches are available at many pharmacies. Since expensive machinery is involved in pouch packaging, generally only online pharmacies with low overhead or major retailers like CVS offer pouches. 

However, some independent pharmacies like ZIKS Family Pharmacy have invested in that technology to better serve their patients. Other independent pharmacies like Carolina Pharmacy use the lower-cost – but equally useful – blister packaging. 

If a patient is struggling with adherence, it doesn’t hurt to ask whether their pharmacy provides multi-dose packaging. Even if the pharmacy can’t pre-sort and package medications, they may be able to help in other ways. Pandemic or not, it’s important to stick to medication regimens. Stay out of the hospital and stay safe.