Other studies and anecdotal information show even lower data for compliance depending on the drug. For example, more than 50% of health maintenance organization patients stopped taking their depression medications within two months. The reasons vary: difficulty in opening packaging, forgetfulness, and not wanting to bother. The cost of non-compliance for pharmaceutical companies and pharmacies is high, according to the Task Force for Compliance, a group of 20 major pharmaceutical companies that released data in 1994. The group found that if 20% of prescriptions are never filled or refilled, the gross loss to pharmacies would be $8 billion, with another $1.6 billion lost on pharmacy dispensing fees. Including unnecessary hospital admissions, premature death, loss of productivity, and other costs, the cost of noncompliance hovers around $100 billion annually in the United States alone.
The Rise of Unit Dosing
Mayberry says more accessible packaging, such as unit-dose blisters, could help with compliance. But most prescription pills in the United States are still delivered in large bottles, then counted and put into smaller plastic bottles by pharmacists. Europe, by comparison, uses mostly blister packaging. Not much innovation has been made in plastic bottles in the past 20 years, he says, although the Healthcare Compliance Packaging Council did give an award last year to a hybrid container designed by One World DMG. The NextBottle, which can be stacked like cans on pharmacists' shelves, is designed in a unit-dose format, containing concentric circles of pills inside a flat, wide bottle with a cap.
"All existing filling lines in place are for the current [bottle] technology," says Henderson. "A lot of the blister packaging technology would require a major investment for pharmaceutical companies to go to all blisters."
Adds Bill Martineau, senior health-care analyst at The Freedonia Group, Inc., a market research company in Cleveland, "Pharmaceutical companies won't do anything unless they get a marketing advantage or it'S required by the government." Besides, he says, "baby boomers don't want to take anything inconvenient. Boomers prefer to take a pill." He says that in hospital drugs there is a trend toward unit-dose packaging to ensure safe dispensing. Most other blister packaging is used for over-the-counter medications or for clinical trials, in which compliance must be monitored carefully.
Demand for pharmaceutical packaging in the United States is expected to increase 5.5% annually, from $12.2 billion in 2007 to $16 billion in 2012, according to a recent report compiled by The Freedonia Group (see Table 1, p. 37). Even though plastic bottles are predicted to see below-average growth, from $2.2 billion in 2007 to $2.6 billion in 2012, they will remain the most widely used package for oral drugs distributed in bulk and prescription doses to retail and mail order pharmacies. Blister packaging is predicted to sustain favorable growth, from $1.6 billion in 2007 to $2 billion in 2012, because of its adaptability to unit-dose formats with expanded label content, high visibility, and built-in track and trace features. The market for pharmaceutical pouches is expected to expand quickly, pushed by increasing applications in the unit-dose packaging of transdermal patches, powders for reconstitution, and topical creams and ointments.
"Bottles will always be cheaper," says Georgia Mohr, marketing manager of pharmaceutical blister products at Reynolds Flexible Packaging in Downing-town, Pa. Her company makes blister and pouching as well as other packaging, including the convenience pouches containing two tablets that are sold at airports. "We are seeing pouching growing 5% to 7% per year and blisters growing at the same rate," she says. "But it will always be cheaper to put pills into bottles. There may be a critical mass for blister packaging in another 10 years." In addition, pouches and bingo cards are being looked at for patients who take multiple drugs at different times of the day.
Room for Improvement
Grinnan also sees blister packs penetrating the market in a big way. "But it requires dexterity and strength to peel the blisters, so a lot of solutions available for blisters don't work well," he says. His company and others are trying to figure out ways to make blister packs that are easier to open, are more portable, and provide more information. Blister packs could also extend shelf life; they help keep out moisture and gases, like oxygen, that can degrade pills. But other than the oft-quoted Ohio State University study, says Henderson, "There isn't as much academic research [on packaging] as you'd like to see. The focus is on upstream chemistry rather than packaging."
One of the newer packages Reynolds makes is the Safety-Pak Plus, a peel and push blister pack with a broader sealing window that can be sealed at lower temperatures during assembly. Mohr predicts a demand from boomers for wallet-type blister packs that open like a bifold; the outside of the package could be used as a billboard for consumer information. "Baby boomers are very mobile. They lead very active lives, so they need a reminder, like in a BlackBerry, to refill the pills," she says. "They want their medications in delivery systems they can transport easily, like transdermal, blister-unit doses or an inhaler. It must be mobile, easy to use, convenient, and have visual indicators to help them."
Cadmus Healthcare Packaging in Charlotte, N.C., has a license to produce the carton for the Discreet Dose Slider developed by the Finnish-Swedish company Stora Enso Pharmaceutical Solutions in Morris Plains, N.J. The package has a locking mechanism that the company says is easy for seniors to open yet difficult for children; the mechanism has been rated F-1, the highest rating given by the U.S. Consumer Product Safety Commission, indicating that the package prevents a child from accessing even a single dose.

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