Overview of Medication Adherence Packaging | | RxEconsult

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Overview of Medication Adherence Packaging Category: Pharmacotherapy by - February 3, 2014 | Views: 33066 | Likes: 4 | Comment: 0  

Medication Non-Adherence

Medication non-adherence is a growing problem and an important factor in rising health care costs as well as patient outcomes. More than half of Americans have at least one chronic disease. There are more than 170 million cases of Americans who have cancer, diabetes, lung conditions, hypertension (high blood pressure), heart disease, stroke, and mental disorders. In the United States, these chronic diseases are the leading causes of death and disability. They account for 91% of all prescriptions filled, 81% of all hospital admissions, and 76% of physician visits. Medications are the routine treatment for most of these chronic illnesses. However, evidence has shown that many patients are non-adherent and do not take their medications appropriately. Some potential reasons and factors for non-adherence include forgetfulness, having other priorities, lack of information, complex medication regimen, drug side effects, or extreme poverty. Medication adherence packaging may help improve compliance. 

Also Read: How to Improve Medication Adherence

What is Medication Adherence Packaging

Traditional bulk packaging contains one type of medication in each package for multiple single doses. Examples of this are bottles and vials. The advantages of this type of packaging are slight transparency, providing protection from heat or light, the option of having child-resistant caps or non-safety caps especially for the elderly, and its low cost. However, traditional bulk packaging does not reduce the risks of adverse events or improve patient adherence.

Medication adherence packaging provides an alternative to traditional bulk packaging by minimizing or preventing the risk of adverse events and improving adherence through various features.There are different types and forms of medication adherence packaging such as unit dose, blister packs, birth control compacts, and many more. Evidence from clinical studies has shown that medication adherence packaging helps patients take their medications properly and consistently. This is most helpful in patients who have several chronic diseases that require multiple medications over a period of time. Medications that are clearly laid out in the appropriate sequence and interval allow patients to see the pills that need to be taken at a particular time of the day or on certain days of the week, resulting in improvements on medication adherence and overall health.

There have been several clinical studies indicating that medication adherence packaging may be a simple method to improve adherence in patients with multiple chronic diseases. In one study, blister packaging was compared to traditional bottles and adherence was assessed by how often the patients refilled their medications. Patients with the blister packaging refilled their prescriptions more often and on time compared to those with the traditional bottles. Another study showed that patients with unit dose packaging found it easier to remember and take their medications regularly. However, further research is needed to better understand the impact of medication adherence packaging on patient adherence.   

Medication Adherence Packaging

Types of Medication Adherence Packaging

Unit Dose Packaging

Unit dose packaging contains only one dose with no more than a 24-hour supply of doses. This is usually available in patient-care areas such as hospitals or clinics.

The advantages include:

  • Easily count medications and distribute it properly to patients
  • Pre-measured to minimize or prevent the risk of a dose being measured incorrectly
  • Patients are charged for only the medications that they actually receive instead of an entire bulk bottle
  • Easily notice if the package has been damaged or opened
  • Each dose can be barcoded to allow for new technologies
  • Patient bedside scanning and electronic chart documentation

The disadvantages include:

  • Not very profitable for drug manufacturers
  • Hundreds of common drugs are not available in unit-dose packaging

Calendar Blister Packaging

Calendar blister packaging has printed prompts and calendar reminders. Some may be perforated allowing patients to tear and carry medications for a certain amount of days instead of carrying around the entire month. It can also be color coded for a specific time of day or day of the week.

Birth Control Compacts

Birth control compacts are multi-piece cases with inserted drug carriers. They are discreet and conveniently sized to be carried on the go.


Networking for doctors, nurses, pharmacists

A DosePak is a paperboard wallet-sized blister designed with dosing instructions or a calendar. It is especially helpful for patients who need to taper down their medications. 


A ShellPak is a thin, molded case with blister access. It delivers patient medications accurately, safely, and in controlled single doses. The shell provides pill protection as well as child-resistant technology.

The following are the advantages and disadvantages of calendar blister packaging, birth control compacts, DosePaks, and ShellPaks.

The advantages include:

  • Increase in patient adherence
  • Provide a simple, clear method of showing the medications that need to be taken on a regular basis
  • Helpful for patients who struggle with bottles or vials
  • Easy to tell how many medications are left
  • Prevent pills from being tampered with
  • Easily notice if package is damaged or opened
  • Safe and efficient
  • Ultimately prevent adverse effects

The disadvantages include:

  • Difficulties with storage
  • Cost

Smart Caps

Smart caps have timers, lights, or buzzers on bottles and vials.

The advantages include:

  • Increase in patient adherence
  • Built-in timer that works just like a stopwatch
  • Indicates when the bottle was last opened  
  • Some pharmacies may give them away with no additional cost

The disadvantages include:

  • Some pharmacies may charge for them
  • Potential malfunction


Taking medications is a complex behavior that involves several aspects. Non-adherence is the most common type of medication error studied in self-care settings. It can impact patient outcomes resulting in unnecessary disease progression, complications, hospitalizations, disability, lower quality of life, and even death. Improving patient adherence through the use of medication adherence packaging may be an effective way to address this issue. Investing in adherence packaging may result in consistent drug consumption, more refills, and better patient outcomes.


American Society of Hospital Pharmacists. (1985). ASHP technical assistance bulletin on single unit and unit dose packages of drugs. American Journal of Hospital Pharmacy. 42: 378-379.

Becker, L.A., Glanz, K., Sobel, E. (1986). A randomized trial of special packaging of antihypertensive medications. Journal of Family Practice. 22(4): 357–361.

Mahtani, K.R., Heneghan, C.J., Glasziou, P., & Perera, R. (2006). Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database of Systematic Reviews. (1): CD005025.

McElhiney, L.E. (2012). Unit-dose packaging. The International Journal of Pharmaceutical Compounding. 2(6).

National Community Pharmacists Association. (2012). PAMA: Pharmacists Advancing Medication Adherence (pp. 1-16).

Quinn, F.J. (2009). The packaging contribution to patient adherence. Pharmaceutical Commerce. Retrieved from www.meadwestvaco.com

Schneider P.J., Murphy J.E., & Pedersen, C.A. (2008). Impact of medication packaging on adherence and treatment outcomes in older ambulatory patients. Journal of American Pharmacists Association. 48(1): 58–63.

So, T. & Wertheimer, A. (2012). Unit-of-use versus traditional bulk packaging. Innovations in Pharmacy. 3(1): 1-6.

Zedler, B.K., Kakad, P., Colilla, S., Murrelle, L., & Shah, N.R. (2011). Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clinical Therapeutics. 33(1): 62-73.

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