The U.S. incurs an estimated loss of $300 billion due to poor medication adherence every year.1 Thankfully in the last 8 – 10 years CMS (the Centers for Medicare and Medicaid Services) has been working to resolve this problem. In 2008, Medicare published a study concerning hospital re-admission rates for high profile chronic conditions from 2004-2006. Data revealed that 25% of heart failure patients were re-admitted for the same problem within 30 days of discharge and 45% within 60 days. Hospitals then submitted for reimbursement again at a full rate. Medicare realized they needed to engage the hospitals in broader patient care, not just institutional care. This increased responsibility forced healthcare providers to look at post-discharge performance, including adherence to prescribed medications.
Since this Medicare study, medication adherence has seen increased visibility, thanks to programs like the National Consumers League Script Your Future campaign and work being done by the Council for Affordable Health Coverage and Prescriptions for a Healthy America. The latter has heralded a developing piece of legislation, H.R. 4292: Synchronization & Nonadherence Correction (SYNC) Act of 2015 which would provide for research and the testing of innovative health care delivery models to improve medication adherence.
The efforts of our Congress, CMS and the wide variety of groups working to address the poor medication adherence epidemic are laudable but, they are built on an antiquated pharmacy practice of re-packaging product that undermines safe pharmaceutical distribution and contributes to this poor adherence situation.
The U.S. operates an outdated prescription distribution system, born from compounding pharmacists who manufactured, packaged and delivered directly to patients. This re-packaging process has no place in a world of mass production where automated packaging lines produce millions upon millions of bottles each year. Re-packaging results in dispensing errors that the manufacturers’ original package could have prevented. In addition, the safety provided by a serialized container traveling through a monitored supply chain is compromised, as is product integrity provided by the manufacturers’ original stability-tested containers.
The Healthcare Compliance Packaging Council has been a longtime advocate of improving medication adherence. Compliance-prompting packaging becomes a multi-faceted tool in the complex discussion of improved medication adherence and supply chain safety. By providing visual dosing reminders for the patient and caregiver, it fits well into the Medicare discussion of extending patient care beyond the institution. Additional benefits include decreased dispensing time, increased counseling time and reduced dispensing errors. Although pharmaceutical manufacturers understand these benefits, they have not elected this smarter form of packaging on a broad scale, instead using it sparingly for starter packs and clinical trials. The market hasn’t asked for better solutions and manufacturers have no direct responsibility for patient adherence or health outcomes related to the use of their products, so there has been no driver for broader adoption. Healthcare providers who have economic benefit from improved adherence and responsibility for improved health outcomes have no idea this smarter packaging exists though numerous studies have demonstrated it effectiveness.
The increased focus on medication adherence by Washington requires a broader look at the pharmaceutical supply chain, starting with manufacturing, not post-pharmacy. Better packaging is a powerful tool that could support improved health outcomes and increased pharmaceutical supply chain safety if we simply elect to use it.
1. American Heart Association (2013). Medication Adherence- Taking Your Meds as Directed.
The Healthcare Compliance Packaging Council (HCPC) is a not-for-profit trade association whose mission is to promote the greater use of compliance-prompting packaging to improve patient adherence and patient outcomes which will lead to reduced healthcare costs. The positive effects of this style of packaging have been proven by numerous studies over the past twenty years, yet U.S. pharmaceutical distribution still clings to an antiquated amber vial for a majority of prescriptions. While advances have been made in every facet of our daily lives, life-saving medication packaging remains in a vial introduced in the 1950s. The HCPC is working to change this.
For more information on HCPC, please visit, www.hcpconline.org.