Packaging Trends: NEW TECHNOLOGIES

The Shellpak unit-dose medication package from Meadwestvaco Corp. protects pills with a rigid, plastic shell that offers space for branding and prescription information. The senior-friendly, push-button technology releases the blister card only when the button is depressed, earning Shellpak the highest child resistance rating.

SOURCE: TOM GRINNAN, MEADWESTVACO HEALTHCARE

The Right Package for Aging Boomers

Recyclable, sustainable, and boutique packaging may become the vogue, but low cost and convenience will prevail

It'S a challenge that won't go away anytime soon-child-resistant, yet senior-friendly pharmaceutical packaging. "You want it to be hard to get into, yet easy to get into. That'S not an easy thing to pull off," says Thomas Henderson, vice president of sales and marketing for Chesapeake Pharmaceutical and Healthcare Packaging in Hicksville, N.Y.

Add to that task the preferences of the newest members of the senior set, the millions of baby boomers born between 1946 and 1964. In July 2005, there were about 78.2 million boomers, and, in 2030, there will be an estimated 57.8 million between 66 and 84 years old, according to the U.S. Census Bureau. In 2006, the eldest boomers turned 60 at a rate of 330 every hour. So it'S no surprise that the baby boomer generation will create a huge demand for pharmaceuticals. "The older you get, the more pharmaceuticals you consume," says Peter G. Mayberry, executive director of the Healthcare Compliance Packaging Council in Falls Church, Va.

Pharmaceutical packaging companies are already planning ahead, expecting to meet such boomer requests as "boutique" or discreet packaging that won't reveal the medications they are taking, recyclable and sustainable containers, and packages that are small and easy to transport to fit in with their active lives. More detailed and readable drug information on packaging will be expected, and a rise in blister pack sales is expected for more mobile boomer retirees.

"Boomers don't want pharmaceuticals to look like pharmaceuticals, so we're likely to see the look [of packaging] change, shaped like an iPod or cell phone," says Tom Grinnan, director of marketing and business development in the healthcare business of packaging company Meadwestvaco Corp., Richmond, Va. "Boomers are much more discriminating consumers in terms of brand preference."

More Discerning Consumers

Henderson says that boomers, who grew up in the era of Consumer Reports, want more information on packages. Grinnan adds that in 1985, seniors typically had only one brand choice-no generics-and did what the doctor told them. "Now seniors have choices, and they're not happy with packaging." He cites an advanced-age poll from the Meyer-Hentschel Institute in Saarbr�cken, Germany, which found that 90% of consumers aged 60 or older have trouble opening packaging. The institute also found that almost half of customers want a clearer sell-by date, 30% want more legible labeling, 26% want smaller packages, and 24% want packages that can be opened more easily.

These demands come at a time when large retailers like Wal-Mart and drug stores like Walgreens are in heated competition for customers and are pushing for lower drug prices-some generic prescriptions already are only $4 dollars-and better packages. They hope that meeting these demands will make consumers more compliant and create repeat customers who may buy additional items.

Packaging companies, like drug makers, will have to bear the financial pinch of the popularity of newer drug delivery technologies like extended-release drugs, which need only be taken once weekly or monthly instead of several times a day. In addition, smaller packages are becoming more popular for shipping and storage purposes, and packaging companies are predicting blister packs will become more popular over time, replacing some of today'S twist-cap bottles.

Boomers don't want pharmaceuticals to look like pharmaceuticals, so we're likely to see the look [of packaging] change, shaped like an iPod or cell phone. Boomers are much more discriminating consumers in terms of brand preference.

-Tom Grinnan, Meadwestvaco Corp.

Compliance a Key Factor

At the heart of the hubbub over packaging is compliance-whether or not certain types of packaging, such as strip or blister packs, will make a consumer more likely to take the pills and refill the prescription. A study by Ohio State University'S College of Pharmacy indicated that unit doses-commonly designed as flat blister packs so consumers can peel and push the pills through foil and plastic-could increase the compliance of seniors taking Merck and Co.'S antihypertensive tablet lisinopril.

Of the 88 seniors aged 65 or older in the study, which was conducted from 2002 through 2004, 48 patients received a 28-day supply of lisinopril in blister packs. The other 40 received the pills in a traditional plastic bottle. After checkups, 48 percent of patients taking the blister-pack lisinopril had lower diastolic blood pressure compared to only 18 percent of those using the bottled drug. Supplying medications in a package that identifies the day each dose should be taken and provides information on proper self-administration can improve treatment regimen adherence and treatment outcomes in elderly patients, the study concluded.

"This indicates improved outcomes and higher refill rates," says Mayberry. He adds that one difference between the senior boomers and their parents is that they are familiar with unit-dose packaging, be cause birth control pills come in packaging labeled with days of the week. "The compliance rates with birth control pills are higher than any drugs in the United States," he says, citing a 1995 study conducted by the National Council on Patient Information and Education. That study found that 92% of patients took their birth control drugs as required, compared with a compliance rate of only 82% for patients taking drugs to prevent organ rejection.

SOURCE: THE FREEDONIA GROUP

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.

We are seeing pouching growing 5% to 7% per year and blisters growing at the same rate. But it will always be cheaper to put pills into bottles. There may be a critical mass for blister packaging in another 10 years.

-Georgia Mohr, Reynolds Flexible Packaging

"Your hand has to be larger than a three-year old'S to open the Discreet Dose Slider child-resistant feature," says David Phillipes, director of business development at Cadmus. One reason for the focus on child resistance is that many seniors have grandchildren who visit them. And, while a bottle whose cap must be pushed down and twisted will keep out kids, seniors with arthritis have a difficult time opening it. Seniors tend to take out the pills and repackage them, so that they're no longer child safe.

Phillipes adds that the slider packaging is made from almost all recyclable components, including paperboard, which taps into another boomer desire: recyclable packaging. "The biggest thing baby boomers want is a recyclable package or something that'S sustainable, meaning traceability all the way back to the forest," he says. "But there'S a cost issue. I do see some of the pharmaceutical companies are willing to pay a little bit more for a 100% paper board package with no plastic that is recyclable. It'S the newest trend, which is why we jumped onto the Discreet Dose Slider bandwagon." He says other companies are aiming at recyclability as well, as are Wal-Mart, some of the big pharmaceutical companies, and consumer companies like Procter and Gamble.

But planning and acting are two distinct things. "No one wants to pay the cost for packaging that is senior friendly, child resistant, and costs a little bit more," Phillipes says. "So managed healthcare and the Wal-Marts will drive the packaging, not the baby boomers.