Opportunities in pharmaceutical RFID and smart packaging
By Dr Peter Harrop, IDTechEx
RFID in healthcare is growing rapidly and
is forecast to become a $2.1 billion global business by 2016. Smart
packaging for healthcare has multiple applications, including recording
patient use in drug trials, stock tracking, tamper recording,
anti-counterfeiting, preventing medical errors, and child-resistant
When two equally efficacious drugs enter the
market, the one with better compliance by patients is likely to be more
widely used as non-compliance is costly and risky. Medication non-compliance
costs the US alone about $100 billion and 125,000 deaths yearly. It is
responsible for 10% of hospital admissions — $31 billion yearly and 380,000
patients. It is responsible for 23% of nursing home admissions — $15 billion
yearly and 3.5 million patients.
Non-compliance also costs the drug
industry over $8 billion annually in unfilled new and refill prescriptions.
This can be caused by patients being confused over the reason for the
medication and not being fully convinced that their treatment is necessary.
Some patients not get their medication in the first case. If they do,
then 30-50% is not taken correctly, according to MeadWestvaco. Many patients
fail to get refills where prescribed and 28% of over 45 year olds admit to
discontinuing the prescribed medication prematurely. Antidepressants are
particularly bad in this respect. Drug companies have come to realize that
spending heavily on creating new blockbuster drugs is risky and less and
less cost-effective, whereas encouraging patients to take medication
correctly benefits the patient, reduces load on physicians and hospitals and
sell more of existing, non-contentious drugs.
One company, Aardex, has a
plastic bottle of pills that is continuously weighed by a load cell in the
base, thus recording when a pill is removed. These packages are used in drug
trials and they incorporate RFID so that the record can be linked to the
Widespread use will follow cost reduction by use of new finer
electronic and electric inks such as the Parelec Parmod silver conducting
ink used in litho, flexo and gravure printing. Indeed, even semiconducting
and dielectric inks are being developed by Merck and some of these will be
suitable for high-speed printing of replacement for the silicon chip in a
talking or RFID laminate. The printed alternative is cheaper, more damage
tolerant and thinner. Packaging companies Dai Nippon Printing and Mreal are
among those developing printed electronics for packaging.
An example of a
six-month drug trial involving smart blisterpacks is the National Institutes
of Health trial of its antibiotic Azithromycin, using 30,000 smart packages
that record which tablet was taken when. Fischer Clinical Services is
carrying out the trial using smart blister packs from Information Mediary of
Canada. Novartis is also carrying out a drug trial, in this case using smart
blister packs from Cypak of Sweden, a company that uses packager
MeadWestvaco for some of its marketing.
Compliance through packaging:
- assists the medical provider in explaining the optimal prescribed
- enrolls the patient as a participant in their own therapy
- simplifies medication administration for the patient
- provides interaction and prompting, reinforcement and cueing
- creates a permanent and continuous intervention that demands little
involvement by the physician or pharmacist
- supports the brand message all the way to the medicine cabinet
- builds efficacy and integrity
- reduces medication errors
- reduces the development of antibiotic resistant bacteria.
The smart blister pack and plastic bottle reduce the amount of false
data recorded in drug trials and eventually such packs will appear in
the home, probable enhanced by self-adjusting electronic use-by dates
(you overheated it for so long, therefore dispose of it at this earlier
date) and electronic monitoring of degradation in storage and transport.
Tamper recording and supply chain efficiency
Sometimes printing — or
at least partial printing — has been used to make packages that record when
tampering is attempted or achieved. This permits investigators to calculate
where, in the supply chain, attacks typically occur and arrests have been
made using this technology. Cypak is a leader here, incorporating RFID.
Indeed RFID, particularly at item level can help to tackle the recall of
pharmaceuticals where well over 1000 recalls occur every year and they are
less than perfect. The cost is significant, not just the safety aspect. For
example the retail and pharmaceutical markets must absorb $2 billion yearly
from return of outdated and overstocked products.
The World Health Organisation estimates that counterfeit drugs cost the
pharmaceutical industry $40 billion yearly. To combat this, RFID on each
small package, with unique identification of that precise package ("mass
serialization" under EPCglobal numbering and network) permits reverse audit,
called "pedigree" by the pharmaceutical industry.
Pedigree, combined with sophisticated software, permits the origin
and destination of even the smallest package to be known at all times.
The Food and Drug Administration in the US is expected to legislate on
this within the next year or so as the best frequency to use and other
aspects are resolved.
Meanwhile, Pfizer, who will speak at the above conference, is RFID
tagging at item level all Viagra for the US, GlaxoSmithKline is tagging
Trizivir and AstraZeneca and others are rapidly following. Cardinal
Health, TAGSYS and others have developed smart shelves in cabinets,
refrigerators and trolleys that can read such tags for error prevention,
automatic reordering and theft prevention. Wal-Mart has taken delivery
of about three million tagged drugs at item level for improving
automation of stocktaking and customer service and theft prevention in
its pharmacies. Omron and Avery Dennison use gravure printing to create
the antennas on these packages.
technology receiving the attention of the printing and packaging industry is
the EnvisionAmerica system by which an RFID label under the regular label of
patient information electronically records a duplicate of that information.
A device held near then speaks out loud the information to assist the blind,
partially sighted, illiterate, dyslexic and those shaking from an affliction
or in a dark place when they need to read instructions. That is about one
third of all patients, according to studies. Indeed, a study by City
University in London even found that 25% of fully sighted consumers can not
read or have difficulty reading instructions, the figure being 73% for
partially sighted people.
The US Institute of Opthalmology reports that nearly 50% of people
over the age of 65 develop one of three chronic eye diseases, the figure
rising because of the ageing of the population. The EnvisionAmerica
talking label system is now being rolled out across the USA following
years of trials in the Chicago region.
Lithographic and other printing
techniques will be used to print sensors, antennas and eventually the
complete electronic circuits in these and other forms of smart packaging for
pharmaceuticals, including packs that speak to give prompts and
instructions. Meanwhile, for the small runs currently involved, screen
printing usually suffices, with rotary screen printing sometimes in use as
with antennas on ASK RFID labels.
Preventable medical errors
US Institute of Medicine estimates that preventable medical errors in the US
cost $17 billion yearly. A study in the UK National Health Service showed
10% of patients suffer an "adverse event".
While a report by the UK
National Patient Safety Agency says, "No single technology can solve the
NHS's unfortunate habit of giving patients treatments that were intended for
other people, and NHS study has shown that unclear packaging and labelling
is a contributory factor in 25% of reported medication errors." The
demographic time bomb by which patients nurses and physicians are, on
average, getting older, cannot help this situation.
The Aventura Hospital Group reports that 2% of administered doses in
hospitals in the US are incorrect already. AstraZeneca has been a
pioneer in using an electronic handshake based on an innovative form of
"chipless" RFID for error prevention and recording procedures with
Diprivan anaesthetic, over 30 million RFID enabled syringes having been
delivered so far.
Packaging that flashes light
and even speaks when the patient should take the medication will help. So
will packaging with large scrolling instructions in glowing images.
Experimentally, we have electrically operated packages that lock, go rough
(electroactive polymers) or go black when the contents have expired. There
are already packages that call you back if you have taken one pill and
should have taken two and one experimental pack shouts "not now" if you
touch it at the wrong time. This may seem humorous to a healthy person but
it is a lifesaver to the confused elderly and sick, who will increasingly
have to self medicate as the population ages.
Child resistant packaging
Another aspect is child resistant packaging where smarter mechanical and
electrical technologies are being explored for the packaging. The Child
Accident Prevention Trust finds that 20% of under fives can open safety tops
and the move to blisterpacks has made things much worse, with most babies
penetrating them — they use their teeth.
Now that batteries can be printed
on packages or at least applied as very low cost laminates, there is
interest in electrical baby proofing technologies and "active" RFID where
there is a battery in the tag to give longer range and manage sensors.
Indeed, talking packages and compliance monitoring packages all need
batteries and the coin cells currently used are expensive and, with
their spring contacts, unreliable compared to printed versions which
also have the advantage of being thin and environmental as well. Thin
Battery Technologies and Graphic Solutions are among the leading
low-cost battery printers.
For more information on RFID applications,
attend RFID Smart Labels Europe, London 19-20 September
www.smartlabelsEurope.com and read Electronic Smart Packaging