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What Every Pharmacy Owner Must Know About Starting & Running a Compliance Packaging Operation.

What is Compliance Packaging?

Compliance packaging or Adherence packaging are the terms used somewhat synonymously for medications that are provided to patients by day or dose-time. This form of packaging facilitates medication compliance to the patient’s physician-prescribed medications. This form of packaging is commonly distributed in multi-medication pouches (also called strip-packs) or blister cards.

Patients receiving this service from their pharmacy will typically receive either a week or a month’s supply of their medications. Compliance packaging makes medication management easier for the patient by supplying the patient’s medications into blisters for breakfast, lunch, dinner and bedtime (or whatever dose times are prescribed by the physician). The blisters are marked with the day and time for each dose, thereby helping the patient to follow the guidelines of their medication regimen.

Should I Get on the Compliance Bandwagon?

You may want to consider that many pharmacy professionals are looking to Compliance/Adherence as one of the best methods of improving relations with your customer community while also improving your bottom line.

Offering a compliance packaging service to your customers can be one of the best methods to grow your business. You may also want to consider that many of the large, chain pharmacies do not offer this service to their clientele. This fact offers you an advantage in that you can now capture the business that these large chains are overlooking.

Compliance packaging can bring you increased business, improved compliance/adherence ratings, and improved relations with your customers. 

Synchronization

This is the process of getting the patient’s meds to renew/refill at or near the same date on the calendar eliminating the need for separate call-ins and pick-ups. The concept of the appointment-based model (ABM) was conceived in 1995 by an independent pharmacist in California. Prescription synchronization is the key that makes ABM work.

The Appointment-Based Model is where an appointment is scheduled for the patient to come to the pharmacy for their medications to be delivered at one time. During the appointment, the pharmacist can review the patient’s health and medication regimen, provide counseling or medication therapy management. When ABM is combined with Med Synchronization, together they turn a reactive process into a proactive process of contacting patients, reviewing their meds and educating the patient.

Synchronization has the potential to deliver tangible results and the advantages are many:

  • Reduction of phone calls to patient’s physicians for renewals/refills
  • Uniform medication quantities 
  • Synchronization reduces stress over possible missing medications
  • Creates ease of billing for eligible medications
  • Allows for scheduled deliveries

The key benefits of Med Sync and ABM are

  • Increased Revenue
  • Operational Efficiency
  • Stronger Relationships with your patient/customer
  • Improved Clinical Performance

Before undertaking med sync and ABM, a pharmacy should have an idea of the goals to be achieved. The goals may be operational efficiency, increased revenue, improving adherence, improving inventory management or the addition of other clinical services. In any event, measuring the success of these goals should also be considered.

Multi-Med Packaging Options

Multi-Med options for packaging can be delivered in many styles. Each style has its advantages and disadvantages.

Blister Packaging (punch-thru) – the meds can be accessed by pushing the blister and the meds through the vapor barrier. The area to the left of the pills is used for medication labels Pros:Easy identification of medsEasy to determine when med supply is running lowEasier to identify adherance issuesHelps with complicated medication regimensReduces Refill confusion for individual medsCons:Clients without finger dexterity may find it difficult to open a blister to access the meds within.
Blister Packaging (unit-dose) – Each of the blisters are perforated, can be separated from the card and then dispensed to the patient using the medication blister as a pill cup. Each blister is labeled with the contents for easy identification.Pros:Easy identification of medsEasy to determine when med supply is running lowEasier to identify adherance issuesHelps with complicated medication regimensReduces Refill confusion for individual medsBlisters are perforated to allow use of individual blisters as a med cupEach Blister is labeled with patient name and med time as well as medication contentsCons:If a blister is separated from the main card, it may be difficult to track adherance/compliance
Strip-Pack (pouches) – The patient’s meds are packaged into individual plastic cellophane pouches, one for each dose period. Each pouch is labeled with the contents for easy identification.Pros:Easy identification of medsHelps with complicated medication regimensReduces Refill confusion for individual medsConvenient packaging can travel easily without taking the entire week’s supplyCons:If a pouch is separated from the main packaging, it may be difficult to track adherance/compliance
Med-Boxes These are plastic, refillable medication boxes labeled by day and dose periodPros:Easy access to medicationsHelps with complicated medication regimensReduces Refill confusion for individual medsCons:Container is not well protected from drops and spillsNo identification of individual meds contained withinDoes not travel well.

Your Customer Audience

Compliance/Adherence packaging can work well for almost any customer group. It excels for Long Term Care (LTC) and other areas where added visibility and security requirements are necessary. Some of the patient groups experiencing the most success with this form of packaging have been:

  • Hospitals (outpatient)
  • Skilled Nursing Facilities
  • Assisted Living
  • Hospice
  • Behavioral Health Groups
  • Correctional Facilities
  • Veterans & Military
  • Special Care Facilities
  • Schools

Each of the above groups will choose compliance packaging for various reasons. Common reasons are: 

  • Increased security – it is easy to detect and track medication disbursement
  • Convenience – Multi-med packaging enforces synchronization. Synchronized meds reduce stress and confusion for individual meds being renewed at various times of the month.
  • Reduced errors – Using multi-med packaging reduces stress and confusion with possible overdosing or underdosing of meds

Compliance packaging is not for everyone! The best candidates are individuals with chronic conditions who take multiple medications. It is commonly these individuals who often experience adherence issues and for whom medication synchronization and compliance packaging will provide the greatest benefit.

Assembly/Packing

If you have chosen to offer blister cards to your clients, you have choices as to how you will assemble and package each card. The assembly and packaging can be performed fully manual, manually with assist, or automated. 

If you are issuing strip-pack pouches, you will have to purchase a strip-pack machine to assemble the pouch strips. 

Blister Card Assembly/Packing

Manual (Fully Manual)

If when starting your Compliance Packaging operation, you may have very few patients enrolled in the program or you may be working on a shoestring budget. Manual assembly is low-cost but does involve a bit of labor to achieve the final product. Steps involved in a manual packing operation are:

  • Check patient’s profile for eligible meds. 
    • Med Form: Liquids, ointments, creams, and other medications that cannot be easily packaged in a blister card would not be considered eligible
    • Med Size: Some medications may be too large for the blisters in the cards you have chosen.
  • Obtain the doctor’s orders needed
  • Perform the Insurance (or other) Billing for the eligible meds
  • Create the labeling
  • Fill and seal the blister card
  • Hand the filled cards to a pharmacist (or a second person) for verification

Assisted Manual (or Semi-Automatic)

As your operation grows, you may achieve higher productivity and/or improved reliability for certain steps in the filling process. There are many options available to assist your packing and assembly operation. The device choices you will make may be determined by economic factors or by the need in your market for specific packaging styles. These devices usually are manually operated and do not require interfaces to other hardware or software in your pharmacy. 

Some possible device choices would be:

  • For a heat-seal operation, a dual-card oven for sealing of the filled blister cards will double the productivity for the sealing process. 
  • For a cold-seal operation, an automated press will apply even, consistent pressure to each blister card ensuring a secure and lasting seal on each card.

Automation

Full Automation can provide great productivity gains. Some factors involved in choosing full automation may be:

  • Customer demands – you may be able to capture key accounts by adding additional capacity
  • Productivity – you are looking to improve productivity and relieve current process bottlenecks.
  • Personnel – Local/State regulations prohibit additional technicians without an additional pharmacist and you may be running out of space for additional employees

There are many choices for providing automated filling and sealing of blister cards and strip-pack (pouches). Each of the devices will offer a variety of processing speeds and capacities. Factors to consider when looking at these various choices are 

  • Space required: Do you have the space to house the new device?
  • Cost: Do you purchase the device outright or finance the purchase over time? 
  • ROI: Will this purchase give you a return on your investment (in your lifetime?)
  • Ease of use: Will my staff be able to use this device easily? (i.e. without vendor retraining every time you have a new employee)
  • Interface: Will the new device interface with your current hardware and software?
  • Implementation: There are two factors here, time and cost. 
    • What is the cost for installation? 
    • What is the cost of training?
    • What is the timeline for each of the above?

Customer Delivery

A delivery program is essential. Many pharmacies provide delivery programs to Special Care Facilities such as assisted living, skilled nursing, correctional facilities, hospice, and behavioral health groups. Some pharmacies extend their delivery programs to retail patients as well.

You may already have a delivery program in place. In this case, you are already familiar with the issues and cost of running a delivery service. For those of you that do not have a delivery service in place, considerations would include whether you own and run the delivery service yourself or whether you hire a delivery company to perform the service for you.

About Rick Munger

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