In 2004 Deborah Adler was horrified to learn that her grandmother mistakenly took her grandfather’s prescription pills. Then a student at the School of Visual Arts in Manhattan, Adler redesigned her grandmother’s medication bottle and label, so the text would be easier to read. Target Stores later commercialized Adler’s innovation, promoting it as ClearRX™ medication packaging. Any baby boomer whose medicine cabinet has slowly filled with prescriptions over the years can appreciate that better labeling is important. So why is it that today, only one percent of the 3.5 billion prescriptions filled in the US have highly readable labels based on the safety improvements of Adler’s meds packaging makeover?

 It’s easy to see how making a pill bottle label more legible could reduce errors in medication consumption, but I believe that simple innovations in packaging can do much more. I believe “smart packaging” can also encourage healthier behavior.

Medication non-adherence costs the American healthcare system $290B a year¹. People are sick. Meds are available. Non-adherence makes people sicker. Yet the data suggest patients take their medications only 50%² of the time. When it comes to eliminating waste and harm from healthcare, this should be low-hanging fruit. Where are the Ad Council Public Service Announcements? Why haven’t legislators addressed this issue in reform bills? Even corporate leaders within big pharma, retail and the payer communities (people who stand to gain from solving this problem!) have accomplished little. Where is the outrage?

Can packaging really change the way we use products? Evidence from other industries suggests that it can. Gillette’s Mach3 blades use a packaging feature to induce you to replace your razor blades more often that you normally would: A simple, blue ‘wear-strip’ disappears when your blade becomes dull and needs replacing. Similarly, the blue bristles in an OralB toothbrush are designed to fade as they wear, prompting you to purchase a new one. Obviously these packaging features serve the brand-manufacturers’ interests, but they demonstrate how even simple visual cues may motivate behavior change.

There are early precedents for innovative packaging in healthcare, too. In 1963 Dialpak introduced a circular, bubble pack dispenser designed to help women remember to take their birth control pills. When I was a kid my father participated in a decades-long aspirin study. Every day he popped pills out of a blister pack that looked like a holiday Advent calendar—one blister for every day of the month.

Wal-Mart pharmacies recently began using similar blister packaging, since it eliminates the expense of a trained pharmacist counting out individual pills. But such format-only improvements don’t motivate behavioral change.

The crude “state of the art” in medicine adherence programs includes automated phone calls or letters from your pharmacy to remind you to pick up a forgotten script refill. Others use text messages to remind you to take a medication dose. But calls and letters can arrive too late, and text messages are almost always pre-set, meaning they are not responsive to actual behavior. It is annoying to be reminded to take a pill you have already consumed. Worse, it may encourage double dosing.

Successful programs for smoking cessation, exercise, and dieting teach us that social feedback loops are key to effective behavioral change. The best programs combine social dynamics with immediate personalized feedback. They educate, they nurture and they admonish. They coach. We can channel these lessons of behavioral change to improve medication adherence. Smart medication packaging can be the catalyst.  Here’s how:

Today the cost of embedding a microcomputer and wireless chip into medical package is about $5. This is extraordinary. For $5 (the average cost of one pill) we can augment a prescription bottle with wireless communication to enable new powerful behavioral feedback loops. It means we can respond to patient behavior dynamically, offering specific assistance to patients to help them improve their medical adherence.

Last February, my company, Vitality, Inc., launched a product called the GlowCap™, the first internet-connected pill cap. You, as the patient, designate your “alarm” time. Then, if you miss a dose, the bottle cap pulses with light. If you haven’t opened the bottle an hour later, the GlowCap starts playing ringtone every five minutes. Finally, if several hours pass and you still haven’t opened the bottle, you receive an automated phone call to ask you any one of a series of questions: Why haven’t you taken your medication? Do you need a refill? Do you have questions about side effects? Would you like to talk to a pharmacist?

Vitality’s GlowCap also uses its communications capabilities to assess how many pills remain in the bottle. It can send a message to your pharmacy to order more, before you run out of medication.

By responding dynamically to patient behavior, the GlowCap has been able to lift patient prescription adherence well above the average of 50% to greater than 85% (a ratio of doses fulfilled to doses prescribed).

Vitality’s GlowCaps send realtime data sorted by pharmacy, physician, condition, medication, and adherence level. Green: 90% to 100% adherence. Yellow: 80% to 90%. Orange: 70% to 80%. Red:< 70%.

There are additional benefits of wireless data collection with smart packaging: we can extend the information feedback loops to the patient’s doctor and, if you elect, to a family member or loved one eliciting additional social support from those who care about you and your health. Every week your designated loved-one shares in your progress through an email report.

Every month, a progress report is faxed to your physician who can take better care of you because of this new diagnostic information. If your prescription adherence is high, but you still have hypertension, a different medication or lifestyle change may be in order.

One of the most important aspects of feedback is that it’s timely. When adherence is high, GlowCap rewards positive behavior, by sharing the good news with your family and caregivers, or even potentially lowering the cost of your insurance.  All of these feedback loops (personal, social, and financial) complement each other. Taken together, our customers often say they feel like they have a personal health coach.

Soon, smart packaging products will be able to send adherence data directly into your doctor’s electronic medical record (EMR). For now with users permission, we securely share adherence data from each GlowCap with your Google Health, Microsoft Health Vault or Dossia health record (PHR).

All medication (and perhaps many other consumer products) will eventually come in smart packaging. The financial incentives to all parties – employers, providers, insurers, drug manufacturers, as well as patients and their families – make it inevitable. But for now, just as with birth control packaging in the 1960’s, I believe the fastest way to make an impact is to systematize the change. Patients ought to receive smart packaging for FREE and by default, whenever they fill a prescription from their pharmacist. Their choice would be to opt-out, in what Richard Thaler, co-author of Nudge: Improving Decisions About Health, Wealth and Happiness, calls a “smart default.” Since pharmaceutical companies derive the most direct benefit, they should subsidize smart packaging in the short term.

Longer term, as the chart below shows, insurance companies have the most to gain. Simply by improving medication adherence we could cut the costs of treating certain chronic diseases by one-third to one-half. In other words, if deployed widely, we could trim much of that $290 billion in estimated costs to the system that come from medication non-adherence. That would be a significant step forward in transforming healthcare…and your health habits.

David Rose is CEO of Vitality, inc. a company focused on connected-health devices and services. He teaches at the MIT Media Lab and speaks frequently on design and product innovation at conferences and corporate retreats. Last month his own medication adherence was 87%.

Medical Care, 2005, vol. 43, no6, pp. 521-530 Sokol Michael C. ; McGuigan Kimberly A. ; Verbrugge Robert R. ; Epstein Robert S.

Condition	Low adherence care costs	High adherence care costs	Savings per year
Diabetes	$8,867	$4,570	$4,297	48%
HighCholesterol	$6,888	$3,924	$2,964	43%
HighBloodpressure	$10,916	$6,752	$4,164	38%
Multipleailments	$16,498	$8,886	$7,612	46%