Compliance Packaging – Missouri Pharmacy Adherence Month

By Robert Nearhoof, PharmD

Patient adherence to medication can be problematic for anyone, and these problems only intensify and escalate when dosing regimens become more complicated or multiple medications are introduced.

While the average patient may have a difficult time remembering to take all their medication, this task can become especially challenging for those suffering from a mental illness, such as bipolar disorder, schizophrenia, or major depressive disorder. Patients with these conditions may take anywhere from one to eight or more different medications at a time, which are all important in keeping their condition controlled. Their medications also tend to be dosed more than once a day, increasing adherence difficulties. Aside from common barriers to adherence such as cost, lack of disease state awareness, or medication side effects, special consideration should be given to patients with mental illness to help them manage their complicated drug regimens. How can we, as their pharmacist, help them stay adherent to their medications and prevent relapse?

Compliance packaging can be a great way to help these patients. This type of packaging can include, but is not limited to: doc-u-dose, monthly bingo cards, and multi-dose weekly bingo cards. These can be filled in different time intervals, ranging from weekly to bi-weekly to monthly. The doctor, collaborating with the patient and health care team, will determine the time interval that each patient receives. Some patients may benefit from weekly or bi-weekly fills, while others may benefit from receiving their medications monthly. Compliance packaging gives the patient the ability to physically see if they have taken their dose on that day. The number on the cards or packs can match up with the day of the month. This can be a self-check for the patients to know they are taking the correct medications. Having doc-u-dose or multi-dose weekly bingo cards, the patients can take their entire scheduled dose at one time from one source, instead of having to search through multiple bingo cards or bottles to determine if that medication was  taken for that time of the day. This type of packaging also allow for more than one medication in a particular time slot, another great advantage. Time slots for doc-u-dose and multi-dose weekly bingo cards can include morning, afternoon, evening, bedtime.

Those involved in the patient’s care, such as case managers, agree that compliance packaging improves adherence assessment because it is now clear what medication the patient has or has not taken and more accurate information can now be shared with the health care team. At the same time patients with mental illness agree that compliance packaging helps improve their adherence while empowering them to have more control over their health. This makes compliance packaging a big win for both the patient and the entire health care team! Consider implementing this service in your pharmacy today.

Reprinted with permission from National Community Pharmacists Association in the August 2011 issue of America’s Pharmacist. For more information about NCPA, visit

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