Pharmaceutical and Medical Packaging News Magazine
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Originally Published June 1998

SPOTLIGHT

Unit-of-Use Packaging: The Wave of the Future?

Drug repackagers and healthcare providers are fueling the growth of blisters and other unit-dose packages.

by Greg Erickson, Contributing Editor

Also in this article: Packaging Liquids in a Unit-Dose Format

Remember the old saying, "Be careful what you wish for, because you just might get it"? That appears to be the stance of more than a few players in the field of pharmaceutical blister packaging these days. Industry insiders and observers generally agree that the use of drug blisters will grow by at least 12% per year well into the next millennium.

Bob Hartwig, director of marketing and sales for blister-machinery manufacturer Uhlmann Packaging (Towaco, NJ), explains why. Less than 20% of all prescription and over-the-counter (OTC) drugs in the United States today goes into blisters, he says. There are roughly 750 thermoforming machines now in operation domestically. If there were to be growth from that 20% of all drugs to, say, 30% soon, demand for blister machines in the United States would increase dramatically. "That would put tremendous pressure on machinery manufacturers," says Hartwig. "We're quite excited and scared at the same time because it could be almost too much of a good thing."

DRUG REPACKAGERS TAKING THE LEAD

Nearly everyone interviewed for this story is saying that such growth is likely. And all of our sources agree that of several market factors stimulating growth in blister packaging, the most notable is the increase in its use by middlemen who have positioned themselves strategically between drug manufacturers and healthcare providers. In this area, says Joe Bell, director of operations at contract packager Comar Inc. (Buena, NJ), "We haven't even scratched the surface."

The days when hospital personnel walked the halls with trays of paper cups containing medicine are long gone, our sources state emphatically. The risk of human error in such a system has be-come unacceptable to healthcare provid-ers and insurance companies for both ethical and financial reasons.

A few providers are taking matters into their own hands. Perhaps 1% of the total U.S. use of blister packaging machinery, according to Manfred Becker, business manager at Klöckner Bartelt Medipack Inc. (Clearwater, FL), is by providers who repackage drugs from bulk containers into blisters on-site.

Some contract packagers specialize in blister-packing samples for physicians, and will also take on contract packaging when a drug manufacturer does not have sufficient capacity to meet demand.

This can happen suddenly, says Angelo Schepis, executive vice president at Marchesini Packaging Machinery (West Caldwell, NJ), "Many [drug manufacturers] have product that they want to release right away, but they may not be prepared to handle the packaging of it in a short time. When the need is urgent, they go to a contract packager."

A growing percentage of drug manufacturers are relying on those middlemen—call them wholesalers, contract packagers, or repackagers—to do the blister-packaging work for them. The most powerful driver in this movement is compliance.

Bill Arden, marketing manager at TL Systems Corp., Bosch Group (Minneapolis), says, "Patient noncompliance in a drug regime is one of the biggest problems a doctor can have and is becoming bigger as the population ages. Ideally, you could package each patient's medicines individually in order to reinforce compliance."

MEETING THE DEMANDS OF HEALTHCARE PROVIDERS

Kent Sides, business unit manager for pharmaceutical films at materials supplier Klöckner Pentaplast of America (Gordonsville, VA), says, "We are seeing real growth in unit-dose packaging for the healthcare provider—hospitals, prisons, and nursing homes. Providers want to deal less with the issue of people self-medicating. And they want more positive identification of the product."

Unit-dose blisters for solid and liquid pharmaceuticals can be made from Klöckner Pentaplast's Pentapharm vinyl film.

The unit dose traditionally has consisted of one tablet taken from inventory for administering to one patient. That's changing, says Uhlmann's Hartwig. "Now we are seeing typically 30 tablets for a single patient packaged in a blister card. These are often called bingo-card packages." These 30-count cards, he says, are not used as often in hospitals as in nursing homes, prisons, and other healthcare facilities where the patient's stay is a month or longer. "Even if the stay is less than a month, the provider might find it most cost-effective to give out a card of 30 tablets and throw the unused ones away. This provides an excellent means of determining at the end of each day, week, and month whether all the pills have been taken."

In hospitals, Hartwig says, another kind of bingo card is being used. "Let's say you go in for heart bypass or any one of 50 to 100 other standardized treatments. The medical community knows from experience what kinds of drugs will have to be administered. If the patient is taking five drugs," he says, "he could be given five cards, each with pills of a different type, from different companies." Alternatively, the packager can include all five drugs on a single bingo card, creating an illness-specific, procedure-specific, patient-specific card that the hospital will want to keep in stock. The second configuration is probably not one that can be marketed by a single drug manufacturer. Hartwig says, "No one manufacturer makes all the drugs that would be needed in the card."

That's where the type of company that Hartwig calls an "in-between link" to the manufacturer and provider becomes essential. Hartwig says, "The wholesaler buys from a manufacturer and sells to a hospital. These [organizations] have not been packagers in the past. But today they want to get into the business of packaging themselves. With insurance companies and providers trying to reduce cost, more wholesalers are getting into the business with automated equipment and at higher volumes."

"What is driving contract packaging," says TL Systems' Arden, "is cost-cutting on the manufacturers' side." David Sciubba, healthcare sales manager at packaging-materials supplier Hueck Foils LLC (Manasquan, NJ), says, "These repackagers are affiliating themselves with nursing homes and the like. They are carrying out a function that specifically serves each particular customer, with an eye to drug-delivery efficiency and accuracy."

CONTINUED GROWTH EXPECTED

A couple of other trends are worth mentioning. Andy Bolton, marketing manager at American National Can (Chicago), says pharmaceutical manufacturers and their repackager colleagues are changing the configuration of the blister card to increase user-friendliness. And many, especially those getting ready to move a prescription drug to an OTC format, are increasingly using blisters as a marketing tool.

Sciubba says, "The physician's sample headed into a bit of a downward trend three or four years ago when the concept of managed care came in. The belief was that doctors would no longer be making decisions about which drugs to prescribe and that insurance companies would be. That has changed. Now manufacturers are getting into sampling again." And new, glitzy redesigns are being used by those manufacturers for physician's samples in order to attract the attention of their increasingly jaded and overburdened audience.

Lastly, bar coding seems likely to further raise patient compliance. One of the sources interviewed for this article foresees a time when each patient may be given a wrist band that carries one or more bar codes. These bar codes will correspond to blister-pack bar codes and would be used by healthcare providers to further decrease the risk of human error in the administration of drugs.

With so much happening already and so much potential for continued growth, it's no wonder our sources barely seem able to look beyond the next couple of years.

Packaging Liquids in a Unit-Dose Format

Unit-of-use packages for liquids are growing in demand, too. The containers take various forms, from glass ampules and squeezable plastic tubes to thermoformed blisters and cups.

Contract packager James Alexander (Blairstown, NJ) specializes in filling unit-dose glass ampules placed in a variety of packaging configurations. Francesca Fazzolari, president, says, "We're seeing growth in part because the glass ampule is designed for extended shelf life. Pharmaceuticals in even small bulk bottles have a shelf life of as little as 6 months. Using a single-dose ampule with nitrogen flush we can extend that to years."

Goran Adolfsson, president of Norden Packaging Co. (North Branch, NJ), says his company's inexpensive flexible-plastic applicators for pharmaceutical liquids boost convenience. "They are used for such products as oral vaccines and saline solutions and some creams and gels," he says. "They are squeezable, and that makes them easy to use."

Physicians samples for liquids, says Daniel Gerner, president of Packaging Coordinators Inc. (Philadelphia), often take the form of lidded plastic cups and miniature representations of bottles. "The little single-dose plastic bottles are vacuum-formed with break-off tops. These make it very convenient for the patient or consumer to take a dose of cough medicine, for example."