The rationale for reminder packaging and real-world evidence that it works.
For more than 60 years, reminder packaging has helped millions of women take 100% of their birth control pills.
Birth control pills are more than 99% effective at preventing pregnancy, but only if every dose is taken. Given this, it’s easy to understand why, when this medication was introduced more than 60 years ago, pharmaceutical companies moved so quickly to package it in reminder packaging. The results have been nothing short of remarkable. The adherence rate for birth control pills is close to 100%. Studies have found fewer than 14% of women on this medication miss more than one dose a month. And the dosing issues that typically contribute to non-adherence are conspicuously absent.
Why, then, given these results, isn’t reminder packaging used for all medications?
There is no rational answer to this question because the arguments against using it are easily debunked and the arguments for using it are compelling.
The arguments against using reminder packaging are:
It isn’t needed. Response: The adherence rates for medications for chronic conditions are 50% - 60%, on average, which suggests more can be done to increase adherence.
It doesn’t work. Response: While it is true that studies of non-adherent patients have found reminder packaging doesn’t work, real-world implementations and studies of adherent patients have found that it does. This is not a contradiction, as most adherent patients want to take every dose while most non-adherent patients have made a conscious decision, that reminder packaging is unlikely to overcome, to be non-adherent.
It only addresses forgetfulness. Response: While reminder packaging can help patients when they can’t remember whether they’ve taken their dose, its real value, as evidenced by the difference in the adherence rates for birth control pills and medications for chronic conditions, lies in helping patients develop an “adherence habit” by providing feedback on their dosing history.
By the time patients realize they’ve forgotten a dose it is often too late to do anything about it. Response: While this is true in some instances, as previously indicated, reminder packaging’s value lies in helping patients develop an “adherence habit” by providing feedback on their dosing history.
It’s confusing. Response: Based on the higher adherence rates for real-world implementations and studies of reminder packaging, it is significantly less confusing to patients than the traditional packaging used for most medications. One sets patients up for success and the other sets them up for failure.
It’s expensive. Response: Reminder Packaging’s cost is low and it’s easy to scale. It empowers patients to follow dosing schedules, increases adherence rates, improves health outcomes, and increases sales. The thing that’s expensive is non-adherence.
The arguments for using reminder packaging are:
It’s empowered millions of women for more than 60 years to achieve 95%+ adherence rates on birth control pills.
Studies have found it increases adherence rates by 14%.
It’s an evolutionary, not revolutionary, change to current packaging.
It’s simple. No electronics.
It’s easy to scale - leverages existing fill lines and distribution networks.
Ease of use. Patients don’t have to do anything. Just select or set it to their first dose.
It’s habit-forming.
All stakeholders benefit from higher adherence rates.
Child safety. Reminder packaging decreases the use of pill boxes, which aren’t child-resistant and are a major source of child medication poisoning.
All of this suggests that the reason reminder packaging isn’t used for all medications may be the difficulty associated with changing the status quo. If so, it is time to acknowledge that the status quo isn’t working and change it.