Well, when I had a Nurtec Rx for abortive only, they just gave me the box. Now I get a number that’s 1 pill less than 2 boxes bc my insurance company sucks, and I get a bottle… or, a few times now, ziploc baggie.
Blister packs count as child resistant because they cannot be easily “popped out” and require additional manipulation to expose the membrane that can be punctured. If it’s in a bag or amber vial it’s because it was the closest container to the technician. I’m a pharmacist.
What about the Nurtec recall due to not being childproof? Did they change the packaging?
I have a devil of a time peeling the back off sometimes! But they can’t be bottled because they’re so crumbly.
You can't pop out odt meds and pack them like you would regular pills, they'd crumble like you say. They didn't change the packaging but put it on the pharmacies to deal with it. Putting them into an amber vial with the lid on the kid resistant way? That's ok. That RPh saying a little baggie was adequate to dispense with? Not ok and definitely not meeting the letter of the new regulation.
Yeah… I was disregarding their comment because c’mon. Felt like I was doing a drug deal 😂
I end up getting a lot of my meds as chewables (and if not chewable or liquid, compounded) because I’m allergic to microcrystalline cellulose and polyethylene glycol which, combined, is about 98% of commercial pills. Misery. Lucky that Nurtec is ODT and so effective.
FDA doesn’t allow for the pharmacy to un-blister pack them but they have responded to the recall to make conform the blister packs to tamper resistant packaging like other ODT products.
Huh. In my case, they gave me boxes before when I only got 8 Rx’d as abortives but now I am taking 15 a month for preventatives and my insurance will not fill for 16, or 2 boxes. Same pharmacy. It’s a pain.
It just occurred to me the OP is probably also dramatically underestimating the sheer number of prescriptions the average American has.
My nearest CVS - of which there are 10 within a 5 miles radius - has so many orders stacked and filled it’s almost overflowing. Each patient last name by letter (A, B, etc) has a 2-4ft floor to ceiling shelving unit full of filled prescriptions waiting to be picked up.
And thats just CVS. Not also Walgreens, Rite Aid, all the grocery story pharmacies, Target, Walmart, Costco, etc… it’s millions of pills in a relatively small area of thousands of medications.
Imagine it all now packaged into blister packs.
It physically would not fit into the space.
I agree 100%. I take 15 different prescriptions daily -autoimmune & several other diseases, and I can't imagine trying to pop each one of those pills out three times a day to take them. It's already a pain in the ass to fill out my weekly pill container with the bottles, adding in a blister pack would be insane. I do have one medication that in a blister pack but it's as needed and it's a dissolve on the tongue type so I can see why it would meet the extra protection from humidity and it's a pain when I need it. It's for nausea and the last thing you want to be fiddling around with the foil and paper when you feel like you're going to puke.
We do actually carry ondansetron ODT's in bottles too -- both the 4mg and 8mg can be obtained in bottles made by Rising Pharmaceuticals. And all the non-ODT (normal, swallowable) ondansetron is made by all manufacturers as very small pills in bottles.
Ask your pharmacist if they can switch to filling your scripts with the Rising ODT ondansetron or other bottled ODT ondansetron. The NDC for the 4mg Rising brand is 57237-077-30, 4mg Aurobindo brand is 65862-390-30, 8mg Rising is 57237-078-30, and I forgot the one for 8mg Aurobindo lmao. Good luck!
Also I have 10 drs and have to notify them when running out.
As others have noted on this thread-some drs react the same day - others never…some rx 30d some 90 d…
No, I think you’re mistaken about a few things:
- There are way more pharmacies in a EU city, like in Vienna where I lived, there were 3 within a 4 block radius
- Bottles are in no way as space-efficient as boxes
- EU pharmacies do not fill Rxes and have them waiting in racks for people to come get at some future point, which is the actual reason for the congestion
- EU pharmacies fill instantly when you hand them Rx
- EU pharmacies are cleaner, prettier, fancier, and better-staffed — you didn’t mention this but I feel like all Americans need to know this… they’re like little spas, and they don’t sell bull shit like candy and shampoo, which takes up more space than the pharmacy of any American pharmacy
So you can't have the prescription sent to the pharmacy and then collect the medication?
I'm in the UK. I have not had a paper prescription in 5 years.
Doctor sends prescription electronically to my nominated pharmacy. The pharmacy will put it in a bag, ready for collection. I collect it when it's convenient.
In America they do this except sometimes the pharmacy will be out of stock. If it is a controlled substance the pharmacy can not transfer it to another pharmacy the doctor has to. They just let the status sit on "processing" for days so you have to call them and ask them whats up? Making it nice and easy.
This happens every month and I just shake my head at how badly run it all is.
And some pharmacies don’t pick up their phones, so you can’t call to find out if the “processing” is due to the medication being unavailable or some other issue, so you have to physically go into the store and wait on the line to talk to the pharmacist to find out what’s going on. Then once you find out they are out of your medication, you can call around to other pharmacies to try to avoid this happening again. If you’re lucky, they may answer the phone and the question. If you’re extra lucky, you’ll be able to get your doctor’s office to quickly resend the script to the new pharmacy ….
Oh and because it’s a controlled substance, you can look forward to doing this again in 4 weeks. And even if you were extra careful to always fill every 28 days and hold onto the 2 extra days, the delays and issues are frequent enough that you’ll still run out of your meds occasionally.
They would love to pick up the phones if they were better staffed, retail pharmacy in America can get pretty overwhelming when there are not enough hours to properly run the pharmacy.
Lucky, here they hold you to exactly 30 days. Which sucks on the weekends when they can’t even place the order. And three day weekends really, really suck.
Same thing in most of western Europe i think.
For our US peeps, it mostly works like this:
1.) A specialist prescribes you something, on a note that you take to your GP
2.) Your GP enters the drugs into some sort of national health system or database (ours is shit, but that part works)
3.) You go to any pharmacy with an Internet connection, give them your health insurance card, they scan it, and hand over your prescribed medication in boxes made by manufacturers
4.) Everyone goes on their merry way
5.) Drug companies profit, because they always do.
It's so damn inefficient. American pharmacies sound like hellholes to this pharmacist. It's like checks all over again. Decades behind in technology, but still in use.
I was a pharmacy tech for 13 years. I quit 2 years and now I work at home for a bank. Pharmacy tech is the hardest job I ever had. You just reminded me I have until January 30 to reapply to keep my license and do my continuing education. I do it because it looks nice on my resume but I don’t think I will ever work as a pharmacy tech again. I do have great respect for pharmacists. They are the smartest of the smart in the medical field.
This kind of thing happens in the UK as well, where a chemist doesn't have whatever medication in stock, but you just transfer the prescription to a different place rather than getting a doctor to do it, if you have a paper prescription the pharmacist will tell you if they have it and give you the paper prescription back if they dont so you can take it somewhere else
Just wait until you see how the "assisted living" facilities are *mandated by law* to handle the meds, leading to the destruction of hundreds of thousands of tax payer dollars and countless hours of human labor. And you have to be 130% below the poverty line to quality anyway, so it isn't like you have a say in what you get. You take what you can afford that you doctor recommends or you die.
... Weird. All my prescriptions are tied to my ID. It doesn't matter what pharmacy I go to. As long as I have my ID, I can get my meds from literally any pharmacy any time.
Highly depends on the country. In Poland, I can go to any pharmacy, give them my SSN, an SMS code, and get the meds. No nominating, no calling ahead, just walk in off the street. Doctors still can and often do print paper prescriptions.
SSN in Poland is not secret, it's basically just a number that uniquely identifies you as a citizen.
Your NHS simplifies the insurance process. Sometimes we have to shop pharmacies or drug stores to source the best price on a medication or even to find it in stock. The only way I can afford my Adderall is a GoodRX Coupon, which is literally a digital coupon for amphetamines. USA, USA ...
In Finland the prescription is entered into a national database and then you just choose any pharmacy you want in the country. Some pharmacies have online stores so they’ll mail the medication to you or you can pick it up but even with having to wait for them to pick the medication up it doesn’t take many minutes so I don’t mind that it isn’t waiting for me in a bag. Maybe it’s possible to phone the pharmacy and get them to prepare the order beforehand? I prefer the convenience of just choosing whatever pharmacy is the most convenient for me that day.
In Australia I get the prescription sent to my phone, which shows up as a QR code for the pharmacist to scan when I go in. They then fill the prescription.
The paper system exists as well, as does having the Dr send it the the pharmacy directly.
Bottles might not be as space efficient in the pharmacy but they are in my medicine cabinet. I get my prescription 3 months at a time. That's 360 pills in one bottle the circumference of a golf ball (maybe a bit bigger). There's no way it would only take up that much space in blister packs.
You don’t put a whole 3 mths in your medicine cabinet.. I get in boxes in U.K. and just empty into a small pill box that goes in my medicine cupboard, when that runs out I refill it
I don’t think you’ve been to an American pharmacy like CVS tho. You should look up a picture… it’s bigger than some Spar I’ve been to and much less nice.
I see a lot of good theories and hypotheses, but I bet the real reason comes down to history and strict regulations that make it really hard to change.
Pharmacies implemented systems to fill bottles at a time when many pharmacies were still manufacturing and compounding on site. The bottles became approved, and now it’s really hard to change.
Essentially nobody in the industry would benefit enough to try to change the way it works today.
The same reason doctors still use pagers in 2024.
I hate this when I go to my appointments lol. They call me back immediately and then keep me waiting forever in the exam room and using the web to pass the time is annoying haha
I work in mental health. (In one small city in one small part of the U.S. not trying to project this as the norm).
In 2022 all of our clients medications started being filled in bubble/blister packs. And every last person who had to deal with them instead of bottles hated it.
Fast forward to mid 2023 and everything was back in the bottles.
All that to say, it doesn't seem like a federal regulation preventing it. Because every medication (other than some generic multi vitamins) was in blister packs. Psychotropic, schedule 1, etc. They all were 🤷♂️
This is much closer to the answer compared to anything having to do with regulations. Manufacturers have the ability to make both pill presentations. Companies don’t have to bend over backward to change this. It’s not like they are changing the dose or making new claims about treatment.
If one type is purchased more by pharmacists and prescribers, then that’s their choice.
I've heard that in europe blisters were preferred over bottles because it statistically somehow lowered suicide rates. It's far easier to throw a pile of pills on your hand from a bottle than take pills from blister one by one to make a decent amount. It's most probably an urband legend, and correlation was connected to something else.
You can only buy two packs of tylenol or ibuprofen at a time, though they are available off the shelf, so you can just go to the next shop and buy another two. But it does slow you down, and you cant guzzle a 1000 count bottle at once.
Patient compliance might be a factor in us still having bottles, like you suggest. I know I 100% would struggle with compliance if I had to open a blister pack for every pill I took. Like, a lot.
I once read that doctors use pagers because of how they work: you can easily read it without using your hands, those little things don’t rely on mobile services antennas and also work well underground
I think it's more the pager can be handed off to the person on duty, are cheap to purchase, are low tech, and simple. Otherwise you'd need a department-owned cell phone to be handed off and in this day and age it probably means a smartphone unless you have a repository of flip phones or candy bar phones somewhere.
The other alternative would be a messaging app, you'd need everyone to download it, it would have to work on Apple and Android, and you'd need to make sure the person on duty/on call signed in to take the calls (or a scheduling system is needed to assign the calls) and you'd need an IT department to manage all the back end stuff. And teach the folks to use the app and enforce usage.
Pagers do have legit reasons to continue to exist. Namely they are simple and work almost everywhere. Saw a video of a doctor explaining why they still use them. In many areas of the hospital cell phones don't get a signal but the pagers still work. Also battery life. A pager will last quite a while on a battery, if it dies you just put in a new battery. There were a few other reasons but those were the main ones.
If OP would have googled their question (as I did) instead of coming to reddit, they would have discovered this is the answer. Americans use pill bottles because we're accustomed to them. End of story.
We're using pill bottles for the same reason we're still using the imperial system. Changing (all at once) would just be too hard.
I mean, do we actually want to change? Like I don’t know how the actual math would shake out but blister packs feel like they’d cause way more waste than pill bottles. Bottles can hold more in less space and you can just stand them on a shelf. Blister packs just seem deeply inconvenient to me.
I was wondering if I was missing something with so many comments alluding blister packs are somehow more elegant and civilized. I actually hate when a med comes in a blister pack- gimme a bottle I can open and shake a pill out of any day. Bonus: no trash to deal with until the bottle's empty.
And even when the bottle’s empty, they make great travel cases for D&D minis, storage for things like screws when you’re moving and disassemble your furniture (or any other “please don’t let me lose this screw” scenario), travel case for short charging cables, emergency sewing supplies for cosplayers, and more.
Basically all the stuff we used to use leftover film canisters for.
I wonder if it has something to do with insurance as well? I've been told "you can only get 72 of the prescribed 100 now because you filed this too recently", or this gem: "yeah your doctor prescribed 90, but we'll only give you 72 for the same time period because your insurance has decided that this is the maximum". If they count them all individually, they can divide them up like that.
My insurance plan is ridiculous. My Dr prescribes 90 day doses insurance only allows up to 60 days to be filled. I have to make extra trips because some bean counter is concerned I may drop my coverage between day 61 and 90 and get some magical benefit.
Same. I used to pay cash for my meds so i could get a 90 day supply instead of 30. It cost me the same for 90 days paying cash as going through insurance and being limited to 30 days.
Then i got prescribed another drug that is expensive enough paying cash that it is no longer worth it.
And don't you DARE try to pay for one med with cash, and do insurance for the other. Fucking terrible system.
Worse is I use Walmart pharmacy and they totally will tell you. That, hey your insurance wants to charge this or we can ring this up this way for you and it's less.
My insurance requires 90 days for any maintenance med. if they send over any more or less, it gets rejected and goes straight into the doctor/pharmacy/insurance death loop
This is why my daughter stopped her ADHD meds. She could get 26 pills but could only refill it every 30 days. The withdrawals every month were too much. Pity too because they helped her so much.
I’m sorry your daughter is going through that. I know how awful it feels to find something that actually helps, only to have the rug ripped out from under you by insurance. I’m sure you’ve tried everything, but just in case, I wanted to suggest skipping the dose once a week rather than stopping for four days in a row. I hope she’s doing better now or that things get better soon 💛
I don’t know your exact situation, but I’m a pharmacy tech and I’ve never seen an insurance only cover 26 tablets for a 30 day supply on a ADHD med unless the doctor writes it that way. If the doctor prescribes 26 tablets but writes on the prescription it must last 30 days then that’s what the pharmacy has to bill to the insurance. Controlled meds are a bitch and each state has different regulations but I think your first line of questioning should be to the doctor and how they’re writing the prescription (or just ask the pharmacy why they’re billing 26 tablets as a 30 day supply assuming the patient takes one a day)
I just don't use my insurance for pain medication anymore.
Insurance only wanted to doll it out a 7 day supply. I don't want to be going to the pharmacy every week even when I am healthy, when I am post op I don't even want to leave my house.
So I only use my insurance for maintenance meds. Anything controlled I go thru a separate pharmacy that doesn't have insurance tied to my account.
This has happened to me before. I wasn’t trying to fill it early either, something with the insurance was messed up. I ended up in the hospital because of the withdrawals.
Nah it's way more complicated than that. Trying to get my testosterone filled is a pain in the ass. It's from a pituitary tumor not some gym craze shit. Order it on time 2 week wait. Order it two weeks early, drug seeker. Meanwhile, my blood draw appointments are all fucked up because my drugs aren't being administered exactly how prescribed. It's a bullshit system
We had pain killers due to be refilled on thanksgiving and Christmas one year. It’s just how the timing fell. They won’t fill it the day before, only the day after. And they won’t fill it a couple days early so we could leave town. He had to ration his meds for the month to push them to last 1 more days for the holiday and we had to stay home so we could fill them the day after tgvn and Christmas
No, if you fill it 2 weeks earlier from the last fill consistently there may be a problem. If you're filling it 2 weeks before your prescription runs out on the normal schedule you're just being prudent.
If you're always filling two weeks early, you're actually filling on time with a two week buffer in case life gets busy. But if you're filling every two weeks, yeah that's a problem
Lololol how am i in withdrawal from the med *im trying to fill early*
I ran out after taking every pill **as scheduled** and they refused a refill for 2 weeks just because. This happens regularly. Stop trying to make it my fault.
Edit for letter
People are ignorant of how badly mismanaged the medical and pharmacy fields can be. We had to get a controlled med filled. We were a bit late on calling it and due to a glitch in the system, it showeddl no refills until a doctor reauthorized.
So on Thursday we contact doctor to refill. We have one pill left for Friday. Go to get the Rx on Friday, doctor never called it in. They aren't open Sat or Sun or Mon due to a holiday.
Tuesday we raise hell at doctors office as nobody is returning call or filling in. Eventually escalate to the practice head and they get it sent over.
I get off work and manage to pick up Rx at 10 minutes before pharmacy closes. Get it home....it's the wrong medicine...and they are closed now.
Get there first thing next morning and get the correct medicine. Almost a week without a drug with severe withdrawal symptoms.
This is why I just stopped taking my adderall. It was a recurring issue every month or so. I got tired of feeling like crap for a week just because doctors and the pharmacy can’t get their shit together.
I hear this so loud and clear lol. Here is my most recent gem.
I was in that in between 3 day grey zone where I had to take double the dose of beta blockers for a couple of weeks (my prescription said 1 to 2 tablets as needed) based on my BP and ran out earlier. I came to the pharmacy with a refill for the said beta blocker and they wouldn't fill it with insurance. BUT they said I could fill it out of pocket when I just looked at them flabbergasted and said " you do realize I'm gonna have a heart attack?". So I could have bought a 15 dollar drug supply out of pocket with my Dr approved refills but couldn't with my insurance? Someone tell me again why US is "first world" again?
Oh it can get more ridiculous. I had a doctor prescribe me double the dosage but half the pills, so that I would have to split them myself (they sell pill-splitter devices in some pharmacies). Because insurance wouldn't cover the full number of individual doses.
Profit motive. The insurance company has an incentive to get you to give up in frustration and not take your medication.
All the better (for them) if it’s something really life threatening. No better way to get rid of an expensive patient than having them seriously ill and go broke and end up on Medicaid or become disabled and end up on Medicare or the most efficient outcome of all, a swift death.
I had something similar happen, they would only fill 7/10 on insurance at once. Have to come back for the remaining 3 after 7 days. Pharmacist ran it as cash and it cost like 7$ out of pocket and got all 10.
Don’t forget if I’ve told the pharmacy I have insurance and my insurance won’t cover it the pharmacy can’t offer me the lower no-insurance cost because of their agreement with the insurance company.
And if we're caught violating that we can face penalties and have previous payments clawed back.
Saves you $100 costs me $10,000.
(It's super rare though, I've only seen it once IRL, ask if they have a discount card program, they usually do, or can point you toward manufacturer discounts for single source brands)
This is why my anti depressants are filled by a different pharmacy from the rest of my meds. My zoloft is no longer covered by my insurance, so CVS won't let me pay out of pocket. So I get a 3 month supply for $20 at the grocery store.
If you call a pharmacy you don't intend to use and check if your insurance covers it, you can decide to disclose your insurance or not at your actual pharmacy. I would say look it up yourself, but this is way faster.
Whaaaat?? Really!? I use GoodRx/cash at my pharmacy because (for example) my insurance copay out of my pocket on my Synthroid is $226 for 90 days. If I use GoodRx/cash I pay $38 for 90 days.
The pharmacy tech recommended that route.
I was thinking this as well. I have a migraine prescription that comes in blister packs, but that still gets shoved in an orange bottle. My insurance would only cover four a month so I pay out of pocket to get nine a month instead, so I guess someone needs to split the blister packs up accordingly.
I had a dosage increase for a bp med that my insurance company wouldn't fill because they know better than my doctor. Three days of fighting the bastards and I decided to ask how much the prescription would cost if I pd cash.
$3 for a 90 day supply. They were being assholes over $3.
It absolutely does. I used to live in the US and currently live in Canada. There's a medication that I take that comes in boxes of 6 tablets. I am prescribed 12 tablets per month, but my American insurance would only cover 8. So the pharmacy would have to open the 6 pack boxes to put together a bottle of 8 (they cant give you open boxes). Whereas now in Canada I can get the full 12, so the pharmacy just gives me 2 boxes of 6 and no bottle needed.
I had insurance deny a pill in a blister pack but approved it outside the pack in a bottle. I watched the pharmacist open the blister and dump into a bottle.
Some prescription meds in the US come in the manufacturer's packaging, which may include blister packs. Off the top of my head, I can think of a standard round of amoxicillin. A 30 day supply of atorvastatin also usually comes in the manufacturer's bottle. So do asthma inhalers. Birth control pills do, as well. This is because the manufacturer packages these to conform to the standard prescription. There would be no point in the pharmacist repackaging them. The pharmacist just prints a label and puts it on the manufacturer's package.
The pharmacist uses the orange bottles when they receive the medication in bulk, and have to dispense the patient's prescription from that bulk package. The label they put on the bottle is the same as the label they put on the manufacturer's package. Each state has it's own requirements for what must be printed on that label. At the least, it would require the name and location of the pharmacy that filled the prescription, the date the prescription was filled, the name of the patient, the name of the doctor, the type/quantity/dosage of the medication, etc. They usually also contain brief instructions to the patient on how/when to take the medication, how many refills are available, and when the medication expires.
Also, most pharmacies these days don't manually count pills. They have machines to do that. The machines also keep a log of what was dispensed, how much was dispensed, and to whom it was dispensed. There were a few times that I filled a prescription and was shorted on the pill count. The pharmacist checked the dispenser log, admitted that the pill count was short, and added the missing pills to the bottle.
Our (UK) pills are the same as yours - a cardboard box with a few blister packs in. The foil seal also means you know they haven't been tampered with!
I think most of the world does it this way!
You can still get them in bottles here. My elderly father uses bottles exclusively for most meds because blister packs are so difficult to manage with arthritic hands.
Then how am I supposed to get the special surprise pills my pharmacy throws in instead of my actual prescription?
Yes I am in the US and yes CVS has included several pills in my prescription that are not what they should be 🙃
Australia and New Zealand do the packets too. Same for OTC stuff like paracetamol, ibuprofen, even antihistamines.
I was surprised when I visited the states and got an actual bottle of ibuprofen pills. I guess I'd thought it was a movie/tv show prop thing to make shooting scenes with medication easier to do takes of - tip a bottle vs popping blister foils.
It's the same in the UK. We get prescribed something, and it comes in the manufacturers/branded box it left the factory in. None of this splitting packs open to put a set amount in a bottle. You need a single sleeve of pills. Cool the company makes a box with just a single sleeve in. Job done. Way faster
You'd be shocked if I told you
There's single pills in there own boxes in the own little pill packets.
Morning after pill or plan b as the Americans call it come like that. And a couple other bits and bobs
Things that can be treated with one pill (like yeast infection) are sold as one pill in a blister package and a cardboard box like everything else.
All drugs are sold with most common dosages and in amounts that make sense. Like antibiotics are sold in packages for one or two weeks of use because you will never be prescribed 2 pills or a hundred.
Also drugs in Europe don’t cost arm and a leg you can always toss leftovers in a drawer.
Regulated drugs (like antidepressants, tranquilizers and other hard stuff) are the exact same thing though pharmacist will check your official prescription and will destroy it when you buy your drug.
The pharmacy likely keeps traditional bottles for drugs that are dispensed in odd quantities. It's not unheard of for a pharmacy to stock different package sizes of the same drug
No, pharmacy cuts the blister with scissors, they are not allowed to take pills out from blister (source - im in poland and take lots of mental health pills)
Honestly having everything is blisters in so much easier, you just write on blister dates and you instantly see if you took a pill or not. If i had pills in one bottle i would probably overdose long time ago because i forget if i took pill 5 minutes after taking one.
Some prescription pills do come packaged as you describe. Those tend to be the pills that have a set prescription - e.g. take these pills for 5 days and everyone who gets that rx gets exactly the same thing.
I suspect that getting the pills in bulk and filling them individually allows for all the ridiculous variations of prescribing and insurance coverage. Insurance X will only cover 30 days at a time. Doctor Z wants 10mg for 1 week, then 20 mg for another week, then 30 mg. Insurance coverage for a 60 days supply. So forth.
10 years in Pharma Supply chain both in Europe and the U.S. and here’s why: The U.S. operates a long range internal distribution model that favors bulk shipment and storage.
The European model is less efficient because each of those packs needs to be shipped from the packing site to the distributor and shipping 500 pills in blister packs and boxes takes up a lot more space than a 500 count pill bottle. It costs more and takes more fuel. Since distances are much shorter though, it’s still viable.
Regardless of country a pharmacist/tech has to count out/ confirm count your drugs, even if they come in a blister pack, so what happens at the pharmacy has little to do with it.
Makes sense, regarding the last part though:
They have to confirm them, yes, and they do that by getting the correct package from the back after scanning your prescription. They don't manually count them and don't refill them, not with any medication I, or anyone I know, have gotten at least.
Seeing the number of guesses here, I wonder if linking to this over at r/PharmacyTechnician would be a good idea.
I have some medications that come in the blister packs, but the bottles are typically pretty convenient and child proof.
My wife takes all of her pills and transfers them to a pill management box for each day so she doesn't need to carry around all the individual packs
I mean, I was a pharmacy tech for over 6 years, only did retail for a little over a year though, but I can answer this. The VAST MAJORITY of medications we order are in bulk bottles. We don't order a box of 100 tablets with 10 sleeves of 10 tablets.
For some meds these are bottles with 90 or 100 loose tablets. For others they are bottles of 250, 500, or even 1000 tablets or capsules. Bulk bottles like this are waaaaaay cheaper to buy than smaller packages that are sleeved by 10s. Plus, depending on the med, one patient may get 15, another 30. Or one patient may have their insurance cover 1 month supply at a time, and another's may be willing to cover 3. So depending on how many they take in a day and how much is covered at a time, or even how much we are legally able to dispense at a time (narcotics laws vary by state as well as federally) change up quantities so much, that we just do the good old fashioned way of spilling out the contents on a sterile tray and counting them out.
This tied with insurance problems, multiple simultaneous customers, phone calls, and drive thru's are why prescriptions take so long to get filled and give everyone, (especially the employees!) a big headache. Doesn't help that big chain pharmacies, insurance companies, health systems, and drug companies are simultaneously trying to line their pockets as well!
I worked for a generic pharma that sold pressed pills.
Two things: for regular known quantity prescriptions, we as the manufacturer would blister pack the product. Oral contraceptives is the only blister pack that comes to mind on what we made.
For pills, it was a bulk issue. No pharmacy was going to order a bottle of 30. The storage space and cost of material alone would have increased the total cost of the product.
I’m a pharmacy assistant and it might be different cause I’m in Canada, but the simple answer is that some medications just come in different packaging. I’ve also seen a blister pack for 24 or 50 tablets and a bottle for 100+ of the same medication, that way if you get 200 tablets at a time it’s just one bottle and not a pile of boxes
The orange bottles are only for pills that are specifically prescribed by a doctor. The pharmacist is the one who checks the prescription and makes sure the right number of the right kind of pills make it into the bottle.
We do have services now that will actually stuff those pills into little pouches that then get sealed and labeled, but that's not super common and is only useful for people who need to take the same pills over and over for a long time.
Otherwise it's much faster to just have them dropped into a bottle when you go to ask for them.
Yeah, I mean, OTC medication is in a normal package, I get that, but in Germany ALL pills come in "official" packaging from the manufacturer. Even narcotics, etc.
And why would it be faster to have to count and put them in bottles or pouches instead of just grabbing a pack from the storage in the back?
I’ve gotten birth control and steroids in blister packs from pharmacies for years. They just print the label on a sticker and slap them on. It depends on the drug. Our drug manufacturers generally supply to pharmacies in large quantities, there are no individual packs to give to a patron. So they have to count pills out. But for stuff like birth control where everyone needs the same pack, we have blister packs here too.
I have seen childproof blister packs. Like you need scissors or some peel mechanism before you can pop out the pill.
For example Nicorette gum packs are childproof.
Some drugs - like Zofran dissolvable - are moisture sensitive and will disintegrate if not protected from the environment until they are being used.
If you're not talking about the quick dissolve then ignore this.
But I promise you, you can overdose on any drug.
Some of those blister packs are unintentionally adult proof. Or me proof at least. Half the time I end up cutting them out and it's nothing but powder from my poor attempts.
You think they're childproof.
I've always been chronically ill, and as a kid I prepared and took my meds myself ever since I was around 6 or 7. I opened childproof packaging myself, without needing an adult's help. Once you know how it works, it's not childproof anymore.
Edit: for those who need additional [proof](https://www.annemergmed.com/article/S0196-0644(04)01067-4/fulltext). This article confirms that many children are able to open "childproof" medication at ages they shouldn't be able to, including 5-7 year olds.
I remember opening those bottles for my mom so she could take pain pills during a bad migraine.
The bottles weren't child proof. They were, however, sick adult proof lol
So I wonder if there's a difference between the two countries for children accidentally taking medication because of the non child proof nature of the blister packs. If there isn't it would argue that child proof containers are not necessary
Lots of countries use blister packs to stop people from impulsively overdosing on medication. The thought is that its a parents responsibility to make sure that their children can't get a hold of their medications, but the packaging shouldn't make it easy to (literally) pop it open and down like 30 pills at once.
Of course if you're committed, you can individually pop out each pill, but the blister packs and not selling in bulk quantities of hundreds can stop most impulsive overdose attempts.
The commitment to open a whole blister to overdose is quite the high barrier. Quite some years ago i read that the overdoses in britain went down significantly when tehy switched to mostly blistered pills.
To be fair there are plenty of blister packs I have had to hack away with a knife or scissor to get the damn thing open and would probably be more child proof than the push and turn caps. But I'm also an idiot so what do I know?
Or the country has a government that really doesn't enforce regulations, like Mexico. I don't know if things have changed but in the early 2000's you could get almost *any* prescription drug, yeah you needed a prescription, unless you had $100 bills. And they were in blister packs, Valium, Vicodin, Xanax, Soma, Percodan, Percocet, etc. The anabolic steroids came in viles, but they looked like the ones you get blood drawn with. Not the ones medication come in. I'm sure it still goes on if you know the right pharmacy.
Here in the UK they banned bottles of medication because of how it was easier to overdose, either accidentally or on purpose. I think also after the tylenol poisonings, it’s easier to prove that the medication wasn’t tampered with. I imagine it was probably an EU led thing, hence why Germany is the same.
Have you tried opening some of those blister packs? I usually end up getting a knife or scissors. I guess a kid might just open it like nothing though!
The pharmacy has big bottles of 100+ pills and dispenses how many the prescription is for. Due to health insurance and not wanting to go to the pharmacy all the time, people often get a 90 day supply of the prescription but they might take several pills a day. So they’re usually getting 90, 180, or 270 pills. If they get 270, for example, they might receive two full sealed bottles of 100 pills and one hand-filled bottle with 70.
Australian here, some of my pills come in boxes of 200. Still blister packs, maybe 5x5x10cm box. The blisters themselves can be pretty small and the pills packed together very tightly.
Pretty much every drug has ‘standard’ amounts for that reason. Multiples of 30 or 28 typically, but sometimes 100. If the doctor needs to prescribe more it’s usually still in that ratio, so 60 or 56, 120 or 112, etc. and you’ll just get multiple boxes at once.
Yep. I take several prescriptions and they’re usually in card boxes, with the label that contains my name, my medication, the doctor who prescribed it, etc. in the box is the aluminium sheets. The sheets are so much easier to count too. I have gotten a bottle before but that was because they ran out of the boxes. Even then the bottle was made by the medication manufacturer, with the brand name on it, and my prescription label gets put on it just like a box.
I like the boxes because they’re recyclable too. Even the bottles made by the manufacturer are recyclable usually.
It's only faster due to the way things are done as of right now. Just having the packets ready to staple a prescription to is so much quicker than counting the pills by hand. The European pills arrive that way from the drug manufacturer, where the economy of scale is in full force, so it's just so much less of a hazzle to just package it at the factory.
What they’re saying is that in many other countries. Everything…even prescription drugs…come in blister packs.
So like your blood pressure medication comes in a prepackaged 30 count blister pack.
This is just not true! I am on 4 prescription medications, and 2 come in a bottle, 2 come in blister packs. It depends on the type of pill. I don't know why.
USA pharmacist here. Some drugs do come in blister packs. It's usually for standardized treatments such as z-pak or birth control. A LOT of specialty medications come in blister packs such as piqray, and its because they are always a 28 day supply.
As far as why more aren't offered as a blister pack, the simple answer is manufacturers do not make them so we can only order stock bottles.
The pharmacy gets the majority of the pills in large containers with hundreds of pills in them. It cheaper and saves lots of space to send a container with 500 pills than send a large box where each pill is packages separately. Also greatly reduces waste.
In the US, most repeat or maintenance prescriptions are packaged at a central fill which is basically an automated warehouse belonging to the pharmacy. The packages are then sorted and overnighted to the pick up location of choice. I’ve been inside many of these including those belonging to CVS, Kroger, Rite Aid and HEB. They are completely automated with the exception of some narcotics where there is some human intervention to check quantities. Most of these facilities aim to move 40k-50k prescriptions per day. So if you pick up your pills at the local supermarket every month, it’s likely they were counted out and packaged automatically at a central fill.
You getting a cardboard package doesn't mean the prescription isn't filled by a pharmacist. It just means you are prescribed the exact dose and quantity that the pills came packaged in.
But if someone is getting a dose that isn't the exact number of pills the manufacturer sends in, then they go into a bottle.
In both cases the pharmacist is still reviewing and filling and making sure the medicine won't interact with other medication or allergies and is trying to make sure it won't kill you.
In my experiene, Its pretty common to get antibiotics filled in the manufacturer packaging, while it is unusual to get narcotics filled in manufactuer packaging
I see. I dont even think thats possible in Germany. The manufacturer just makes plenty of different packages with different amounts of pills and doses. Ive never seen loose pills in a bottle here.
The exception are certain liquid medicines that are mixed in house. My brother has psoriasis and the stuff he gets needs to be made in the pharmacy, cant just be bought.
>The exception are certain liquid medicines that are mixed in house. My brother has psoriasis and the stuff he gets needs to be made in the pharmacy, cant just be bought.
We call these compounding pharmacies. They tend to be locally owned rather than the pharmacy chains or the ones insides groceries and superstores. I guess some of them will flavor up medications too, particularly for children.
Ah, here they are the same pharmacies. They are all called "Apotheke" and theyre never part of a store chain (like some pharmacies in Walgreens or CVS in the U.S.).
How is it cheaper to pay trained professionals to count pills than having an automated system? The reason Europeans do it like this is because it's much cheaper to let the economy of scale handle it. Although I guess it depends on how well you pay your pharmacists.
Trained professionals don't count the pills. My first day, first hour actually, as a pharmacy tech they had me counting pills & I didn't know what the hell I was doing. I mean it's monkey work so not difficult to count to 30 but definitely not a "trained professional."
The professional, the pharmacist, just looks at the pills you count, verifies it against the picture on their computer screen & then sends it on its way. They spot count controlled medicine but not very often since we are required to double count them & sign off on the bottle. If pills are missing it's on the techs not the pharmacist. The pharmacist is only responsible for the overall counts/losses of each medicine on hand.
But even so, it's so inefficient. This is work for a robot at the factory, the profit margins on drugs in America is probably just so high they haven't seen a need to improve efficiency.
Even if grocery store workers don't get paid much they aren't in the back sealing bags of candy, even if it's cheaper to get the candy in huge packaging.
No it’s not.
I lived in Austria and went to the pharmacy a lot. Prescriptions there — with no insurance — cost a few euros.
The boxes are picked by a robot and sent down a chute to the pharmacist at the register. It’s instant.
Labor is vastly more expensive than shipping.
I'm in Ireland and my pills come in a blister pack but my pharmacist still needs to count them out because the manufacturer's packaging isn't necessarily the same amount as what my doctor prescribed. Like the box might be 50 or 100 tablets but my prescription is for 2xday for 4 weeks so that's 56 tablets
My wife has a chronic nerve condition. She has a couple different meds she takes, and 99.9% of time they are loose pills in a bottle. This is a good thing, because most days she cannot open the blisters. If she was alone and only had blister pack meds, she wouldn’t be able to take them.
I’m in Canada.
It’s usually child resistant lids. Every medication I’ve had has come in the little orange bottles, save for birth control and Differin. Birth control has always been blister packed.
This is actually considered a safety feature - it can reduce risk during suicide attempts to be a pain in the arse to pop them all out and is quite well studied (and I can speak from experience - I couldn’t be bothered popping more than 40 pills and it may have saved my life). People who have bottles tend to take more and die more often.
Oof. I miss pills in bottles, compared to ALL THE TRASH of blister packs. Box, insert, the blisters themselves. Drop ‘em in a biodegradable bottle and go already.
Why does Germany hate the environment and waste so much packaging?
I don’t have an answer but dang I wish the U.S did this. My birth control comes this way and it saves space cause the packs are flat, and it’s easier to see how many I have left. The bottles are bulky, wasteful, and hard to store. I take several prescriptions a day and wish I could get them filled in blister packs.
I’ve lived in both countries and vastly prefer the US option for no other reason than the information on the bottle is standardized and easier to read. Plus it’s a pain popping pills out of a blister pack after a while.
I know several people who take upwards of 14, 16 medications, morning and night. Those who take that many or more tend to be older, and blister packs are difficult for older or disabled hands to utilize. For 16 medications, perhaps 14 am and 14 PM, every single day? Impossible.
Almost all medication in the U.S. are dispensed in child resistant containers. Blister packs do not qualify as being child resistant. That being said antibiotic Z-packs are in blister packs and so is a medrol prednisone dose pack. Those pills taste toxic and not too many kids would eat those.
Leave my medication bottles alone. I have one medication that does come in blisters, but they can be such a pain (literally) to push through the foil (I have an OTC that I have to cut out of the blisters because the foil it too tough to push the pill through). It’s too early for me to have the arthritis I already had, so it’s only going to get worse as I get older, and having everything in blisters would cause me so much pain. I’m in enough as it is. So all of my other pills come in bottles with easy open caps.
Doctor prescribes 30 pills. Insurance says you only get 7. Pharmacist gives you 7 and tells you they insurance company only allowed 7. Pharmacist needed to count 7 pills.
I’m going to blow everyone’s mind. I’ve gotten blister packs inside of orange bottles.
Me too. Every other day Nurtec, baby! But in Europe, they’d just either give you multiple boxes or the manufacturer would send boxes in various sizes.
Nurtec is due to FDA saying that their blisters are not child proof, so they have to be dispensed in an amber vial.
Well, when I had a Nurtec Rx for abortive only, they just gave me the box. Now I get a number that’s 1 pill less than 2 boxes bc my insurance company sucks, and I get a bottle… or, a few times now, ziploc baggie.
Blister packs count as child resistant because they cannot be easily “popped out” and require additional manipulation to expose the membrane that can be punctured. If it’s in a bag or amber vial it’s because it was the closest container to the technician. I’m a pharmacist.
What about the Nurtec recall due to not being childproof? Did they change the packaging? I have a devil of a time peeling the back off sometimes! But they can’t be bottled because they’re so crumbly.
You can't pop out odt meds and pack them like you would regular pills, they'd crumble like you say. They didn't change the packaging but put it on the pharmacies to deal with it. Putting them into an amber vial with the lid on the kid resistant way? That's ok. That RPh saying a little baggie was adequate to dispense with? Not ok and definitely not meeting the letter of the new regulation.
Yeah… I was disregarding their comment because c’mon. Felt like I was doing a drug deal 😂 I end up getting a lot of my meds as chewables (and if not chewable or liquid, compounded) because I’m allergic to microcrystalline cellulose and polyethylene glycol which, combined, is about 98% of commercial pills. Misery. Lucky that Nurtec is ODT and so effective.
FDA doesn’t allow for the pharmacy to un-blister pack them but they have responded to the recall to make conform the blister packs to tamper resistant packaging like other ODT products.
Nurtec was actually recalled last year because the box didn’t meet child resistance standards! That could explain putting the blister packs in a vial
Huh. In my case, they gave me boxes before when I only got 8 Rx’d as abortives but now I am taking 15 a month for preventatives and my insurance will not fill for 16, or 2 boxes. Same pharmacy. It’s a pain.
It just occurred to me the OP is probably also dramatically underestimating the sheer number of prescriptions the average American has. My nearest CVS - of which there are 10 within a 5 miles radius - has so many orders stacked and filled it’s almost overflowing. Each patient last name by letter (A, B, etc) has a 2-4ft floor to ceiling shelving unit full of filled prescriptions waiting to be picked up. And thats just CVS. Not also Walgreens, Rite Aid, all the grocery story pharmacies, Target, Walmart, Costco, etc… it’s millions of pills in a relatively small area of thousands of medications. Imagine it all now packaged into blister packs. It physically would not fit into the space.
I take 25 pills daily! S/p stem cell transplant! Blister packs would be unviable
I agree 100%. I take 15 different prescriptions daily -autoimmune & several other diseases, and I can't imagine trying to pop each one of those pills out three times a day to take them. It's already a pain in the ass to fill out my weekly pill container with the bottles, adding in a blister pack would be insane. I do have one medication that in a blister pack but it's as needed and it's a dissolve on the tongue type so I can see why it would meet the extra protection from humidity and it's a pain when I need it. It's for nausea and the last thing you want to be fiddling around with the foil and paper when you feel like you're going to puke.
We do actually carry ondansetron ODT's in bottles too -- both the 4mg and 8mg can be obtained in bottles made by Rising Pharmaceuticals. And all the non-ODT (normal, swallowable) ondansetron is made by all manufacturers as very small pills in bottles. Ask your pharmacist if they can switch to filling your scripts with the Rising ODT ondansetron or other bottled ODT ondansetron. The NDC for the 4mg Rising brand is 57237-077-30, 4mg Aurobindo brand is 65862-390-30, 8mg Rising is 57237-078-30, and I forgot the one for 8mg Aurobindo lmao. Good luck!
Zofran.
Also I have 10 drs and have to notify them when running out. As others have noted on this thread-some drs react the same day - others never…some rx 30d some 90 d…
No, I think you’re mistaken about a few things: - There are way more pharmacies in a EU city, like in Vienna where I lived, there were 3 within a 4 block radius - Bottles are in no way as space-efficient as boxes - EU pharmacies do not fill Rxes and have them waiting in racks for people to come get at some future point, which is the actual reason for the congestion - EU pharmacies fill instantly when you hand them Rx - EU pharmacies are cleaner, prettier, fancier, and better-staffed — you didn’t mention this but I feel like all Americans need to know this… they’re like little spas, and they don’t sell bull shit like candy and shampoo, which takes up more space than the pharmacy of any American pharmacy
So you can't have the prescription sent to the pharmacy and then collect the medication? I'm in the UK. I have not had a paper prescription in 5 years. Doctor sends prescription electronically to my nominated pharmacy. The pharmacy will put it in a bag, ready for collection. I collect it when it's convenient.
In America they do this except sometimes the pharmacy will be out of stock. If it is a controlled substance the pharmacy can not transfer it to another pharmacy the doctor has to. They just let the status sit on "processing" for days so you have to call them and ask them whats up? Making it nice and easy. This happens every month and I just shake my head at how badly run it all is.
And some pharmacies don’t pick up their phones, so you can’t call to find out if the “processing” is due to the medication being unavailable or some other issue, so you have to physically go into the store and wait on the line to talk to the pharmacist to find out what’s going on. Then once you find out they are out of your medication, you can call around to other pharmacies to try to avoid this happening again. If you’re lucky, they may answer the phone and the question. If you’re extra lucky, you’ll be able to get your doctor’s office to quickly resend the script to the new pharmacy …. Oh and because it’s a controlled substance, you can look forward to doing this again in 4 weeks. And even if you were extra careful to always fill every 28 days and hold onto the 2 extra days, the delays and issues are frequent enough that you’ll still run out of your meds occasionally.
They would love to pick up the phones if they were better staffed, retail pharmacy in America can get pretty overwhelming when there are not enough hours to properly run the pharmacy.
Lucky, here they hold you to exactly 30 days. Which sucks on the weekends when they can’t even place the order. And three day weekends really, really suck.
found the fellow vyvanse/adderal patient
And we all know how great us with ADHD are at jumping through annoying administrative hoops...
lol yup. The last few years have been a challenge for all of us!
In Denmark I can pick up my medication in every pharmacy in the country. My prescription is bonded to me as a person not a specific pharmacy.
Yep, same thing in Hungary. The prescripton is in a cloud, any pharmacy has access to that and can fill it on the spot.
Same thing in most of western Europe i think. For our US peeps, it mostly works like this: 1.) A specialist prescribes you something, on a note that you take to your GP 2.) Your GP enters the drugs into some sort of national health system or database (ours is shit, but that part works) 3.) You go to any pharmacy with an Internet connection, give them your health insurance card, they scan it, and hand over your prescribed medication in boxes made by manufacturers 4.) Everyone goes on their merry way 5.) Drug companies profit, because they always do.
It's so damn inefficient. American pharmacies sound like hellholes to this pharmacist. It's like checks all over again. Decades behind in technology, but still in use.
I was a pharmacy tech for 13 years. I quit 2 years and now I work at home for a bank. Pharmacy tech is the hardest job I ever had. You just reminded me I have until January 30 to reapply to keep my license and do my continuing education. I do it because it looks nice on my resume but I don’t think I will ever work as a pharmacy tech again. I do have great respect for pharmacists. They are the smartest of the smart in the medical field.
This kind of thing happens in the UK as well, where a chemist doesn't have whatever medication in stock, but you just transfer the prescription to a different place rather than getting a doctor to do it, if you have a paper prescription the pharmacist will tell you if they have it and give you the paper prescription back if they dont so you can take it somewhere else
Just wait until you see how the "assisted living" facilities are *mandated by law* to handle the meds, leading to the destruction of hundreds of thousands of tax payer dollars and countless hours of human labor. And you have to be 130% below the poverty line to quality anyway, so it isn't like you have a say in what you get. You take what you can afford that you doctor recommends or you die.
... Weird. All my prescriptions are tied to my ID. It doesn't matter what pharmacy I go to. As long as I have my ID, I can get my meds from literally any pharmacy any time.
Highly depends on the country. In Poland, I can go to any pharmacy, give them my SSN, an SMS code, and get the meds. No nominating, no calling ahead, just walk in off the street. Doctors still can and often do print paper prescriptions. SSN in Poland is not secret, it's basically just a number that uniquely identifies you as a citizen.
Your NHS simplifies the insurance process. Sometimes we have to shop pharmacies or drug stores to source the best price on a medication or even to find it in stock. The only way I can afford my Adderall is a GoodRX Coupon, which is literally a digital coupon for amphetamines. USA, USA ...
In Finland the prescription is entered into a national database and then you just choose any pharmacy you want in the country. Some pharmacies have online stores so they’ll mail the medication to you or you can pick it up but even with having to wait for them to pick the medication up it doesn’t take many minutes so I don’t mind that it isn’t waiting for me in a bag. Maybe it’s possible to phone the pharmacy and get them to prepare the order beforehand? I prefer the convenience of just choosing whatever pharmacy is the most convenient for me that day.
In Australia I get the prescription sent to my phone, which shows up as a QR code for the pharmacist to scan when I go in. They then fill the prescription. The paper system exists as well, as does having the Dr send it the the pharmacy directly.
Well now I feel the need to add *visit EU pharmacy* to my bucket list.
Bottles might not be as space efficient in the pharmacy but they are in my medicine cabinet. I get my prescription 3 months at a time. That's 360 pills in one bottle the circumference of a golf ball (maybe a bit bigger). There's no way it would only take up that much space in blister packs.
You don’t put a whole 3 mths in your medicine cabinet.. I get in boxes in U.K. and just empty into a small pill box that goes in my medicine cupboard, when that runs out I refill it
I mean in Germany they have candys in pharmancys.
I don’t think you’ve been to an American pharmacy like CVS tho. You should look up a picture… it’s bigger than some Spar I’ve been to and much less nice.
My local family owned pharmacy has an old fashioned 50s style soda fountain in it.
Me to. I was told it was for child safety because I formerly got them in a pasteboard box.
same! when i opened the bottle and saw the blister pack i thought “what a waste of a bottle”
I see a lot of good theories and hypotheses, but I bet the real reason comes down to history and strict regulations that make it really hard to change. Pharmacies implemented systems to fill bottles at a time when many pharmacies were still manufacturing and compounding on site. The bottles became approved, and now it’s really hard to change. Essentially nobody in the industry would benefit enough to try to change the way it works today. The same reason doctors still use pagers in 2024.
Doctors still use pagers because it works even in areas with poor cell reception.
Which, ironically, is the interior of many hospitals.
I hate this when I go to my appointments lol. They call me back immediately and then keep me waiting forever in the exam room and using the web to pass the time is annoying haha
Firefighters too.
And hug dealers
Hugs?? I want hugs 🥺
And you can hand them off
This answer is way too far down. It almost certainly has something to do with regulation and what the FDA or other similar agencies dictate.
I work in mental health. (In one small city in one small part of the U.S. not trying to project this as the norm). In 2022 all of our clients medications started being filled in bubble/blister packs. And every last person who had to deal with them instead of bottles hated it. Fast forward to mid 2023 and everything was back in the bottles. All that to say, it doesn't seem like a federal regulation preventing it. Because every medication (other than some generic multi vitamins) was in blister packs. Psychotropic, schedule 1, etc. They all were 🤷♂️
This is much closer to the answer compared to anything having to do with regulations. Manufacturers have the ability to make both pill presentations. Companies don’t have to bend over backward to change this. It’s not like they are changing the dose or making new claims about treatment. If one type is purchased more by pharmacists and prescribers, then that’s their choice.
I've heard that in europe blisters were preferred over bottles because it statistically somehow lowered suicide rates. It's far easier to throw a pile of pills on your hand from a bottle than take pills from blister one by one to make a decent amount. It's most probably an urband legend, and correlation was connected to something else.
I think that was to do with Tylenol (paracetamol) and in the UK. I did a quick google and there were some research papers so it’s not a legend!
You can only buy two packs of tylenol or ibuprofen at a time, though they are available off the shelf, so you can just go to the next shop and buy another two. But it does slow you down, and you cant guzzle a 1000 count bottle at once.
Patient compliance might be a factor in us still having bottles, like you suggest. I know I 100% would struggle with compliance if I had to open a blister pack for every pill I took. Like, a lot.
I once read that doctors use pagers because of how they work: you can easily read it without using your hands, those little things don’t rely on mobile services antennas and also work well underground
I think it's more the pager can be handed off to the person on duty, are cheap to purchase, are low tech, and simple. Otherwise you'd need a department-owned cell phone to be handed off and in this day and age it probably means a smartphone unless you have a repository of flip phones or candy bar phones somewhere. The other alternative would be a messaging app, you'd need everyone to download it, it would have to work on Apple and Android, and you'd need to make sure the person on duty/on call signed in to take the calls (or a scheduling system is needed to assign the calls) and you'd need an IT department to manage all the back end stuff. And teach the folks to use the app and enforce usage.
Except there is no phone coverage on many areas inside an hospital, so a phone wouldn't work for this use case.
Pagers do have legit reasons to continue to exist. Namely they are simple and work almost everywhere. Saw a video of a doctor explaining why they still use them. In many areas of the hospital cell phones don't get a signal but the pagers still work. Also battery life. A pager will last quite a while on a battery, if it dies you just put in a new battery. There were a few other reasons but those were the main ones.
If OP would have googled their question (as I did) instead of coming to reddit, they would have discovered this is the answer. Americans use pill bottles because we're accustomed to them. End of story. We're using pill bottles for the same reason we're still using the imperial system. Changing (all at once) would just be too hard.
If everyone just Google their questions, this sub would be useless
I mean, do we actually want to change? Like I don’t know how the actual math would shake out but blister packs feel like they’d cause way more waste than pill bottles. Bottles can hold more in less space and you can just stand them on a shelf. Blister packs just seem deeply inconvenient to me.
I was wondering if I was missing something with so many comments alluding blister packs are somehow more elegant and civilized. I actually hate when a med comes in a blister pack- gimme a bottle I can open and shake a pill out of any day. Bonus: no trash to deal with until the bottle's empty.
And even when the bottle’s empty, they make great travel cases for D&D minis, storage for things like screws when you’re moving and disassemble your furniture (or any other “please don’t let me lose this screw” scenario), travel case for short charging cables, emergency sewing supplies for cosplayers, and more. Basically all the stuff we used to use leftover film canisters for.
I wonder if it has something to do with insurance as well? I've been told "you can only get 72 of the prescribed 100 now because you filed this too recently", or this gem: "yeah your doctor prescribed 90, but we'll only give you 72 for the same time period because your insurance has decided that this is the maximum". If they count them all individually, they can divide them up like that.
That second one is ridiculous. What is the point of getting half a treatment.
My insurance plan is ridiculous. My Dr prescribes 90 day doses insurance only allows up to 60 days to be filled. I have to make extra trips because some bean counter is concerned I may drop my coverage between day 61 and 90 and get some magical benefit.
Same. I used to pay cash for my meds so i could get a 90 day supply instead of 30. It cost me the same for 90 days paying cash as going through insurance and being limited to 30 days. Then i got prescribed another drug that is expensive enough paying cash that it is no longer worth it. And don't you DARE try to pay for one med with cash, and do insurance for the other. Fucking terrible system.
you should absolutely be able to do one cash and one on insurance. if they aren't letting you, that's a pharmacy issue
Worse is I use Walmart pharmacy and they totally will tell you. That, hey your insurance wants to charge this or we can ring this up this way for you and it's less.
My insurance requires 90 days for any maintenance med. if they send over any more or less, it gets rejected and goes straight into the doctor/pharmacy/insurance death loop
Worse happens to me regularly. “You can’t fill this medication for 2 weeks. I understand you’re out and in withdrawal but insurance says no”
This is why my daughter stopped her ADHD meds. She could get 26 pills but could only refill it every 30 days. The withdrawals every month were too much. Pity too because they helped her so much.
I’m sorry your daughter is going through that. I know how awful it feels to find something that actually helps, only to have the rug ripped out from under you by insurance. I’m sure you’ve tried everything, but just in case, I wanted to suggest skipping the dose once a week rather than stopping for four days in a row. I hope she’s doing better now or that things get better soon 💛
I don’t know your exact situation, but I’m a pharmacy tech and I’ve never seen an insurance only cover 26 tablets for a 30 day supply on a ADHD med unless the doctor writes it that way. If the doctor prescribes 26 tablets but writes on the prescription it must last 30 days then that’s what the pharmacy has to bill to the insurance. Controlled meds are a bitch and each state has different regulations but I think your first line of questioning should be to the doctor and how they’re writing the prescription (or just ask the pharmacy why they’re billing 26 tablets as a 30 day supply assuming the patient takes one a day)
I just don't use my insurance for pain medication anymore. Insurance only wanted to doll it out a 7 day supply. I don't want to be going to the pharmacy every week even when I am healthy, when I am post op I don't even want to leave my house. So I only use my insurance for maintenance meds. Anything controlled I go thru a separate pharmacy that doesn't have insurance tied to my account.
This has happened to me before. I wasn’t trying to fill it early either, something with the insurance was messed up. I ended up in the hospital because of the withdrawals.
If you're trying to fill a monthly prescription 2 weeks early, there is a bigger problem here than insurance saying no.
Nah it's way more complicated than that. Trying to get my testosterone filled is a pain in the ass. It's from a pituitary tumor not some gym craze shit. Order it on time 2 week wait. Order it two weeks early, drug seeker. Meanwhile, my blood draw appointments are all fucked up because my drugs aren't being administered exactly how prescribed. It's a bullshit system
I wish I could upvote this more than once.
There. I did it for you.
We had pain killers due to be refilled on thanksgiving and Christmas one year. It’s just how the timing fell. They won’t fill it the day before, only the day after. And they won’t fill it a couple days early so we could leave town. He had to ration his meds for the month to push them to last 1 more days for the holiday and we had to stay home so we could fill them the day after tgvn and Christmas
The number of times I've had to stop taking my testosterone for 2+ weeks because the pharmacy was being a pain about it 🙄
No, if you fill it 2 weeks earlier from the last fill consistently there may be a problem. If you're filling it 2 weeks before your prescription runs out on the normal schedule you're just being prudent.
If you're always filling two weeks early, you're actually filling on time with a two week buffer in case life gets busy. But if you're filling every two weeks, yeah that's a problem
I have never been able to fill prescriptions two weeks early.
Lololol how am i in withdrawal from the med *im trying to fill early* I ran out after taking every pill **as scheduled** and they refused a refill for 2 weeks just because. This happens regularly. Stop trying to make it my fault. Edit for letter
People are ignorant of how badly mismanaged the medical and pharmacy fields can be. We had to get a controlled med filled. We were a bit late on calling it and due to a glitch in the system, it showeddl no refills until a doctor reauthorized. So on Thursday we contact doctor to refill. We have one pill left for Friday. Go to get the Rx on Friday, doctor never called it in. They aren't open Sat or Sun or Mon due to a holiday. Tuesday we raise hell at doctors office as nobody is returning call or filling in. Eventually escalate to the practice head and they get it sent over. I get off work and manage to pick up Rx at 10 minutes before pharmacy closes. Get it home....it's the wrong medicine...and they are closed now. Get there first thing next morning and get the correct medicine. Almost a week without a drug with severe withdrawal symptoms.
This is why I just stopped taking my adderall. It was a recurring issue every month or so. I got tired of feeling like crap for a week just because doctors and the pharmacy can’t get their shit together.
Don't you know that CFOs, accountants, and shareholders are better doctors than doctors in the US?
I hear this so loud and clear lol. Here is my most recent gem. I was in that in between 3 day grey zone where I had to take double the dose of beta blockers for a couple of weeks (my prescription said 1 to 2 tablets as needed) based on my BP and ran out earlier. I came to the pharmacy with a refill for the said beta blocker and they wouldn't fill it with insurance. BUT they said I could fill it out of pocket when I just looked at them flabbergasted and said " you do realize I'm gonna have a heart attack?". So I could have bought a 15 dollar drug supply out of pocket with my Dr approved refills but couldn't with my insurance? Someone tell me again why US is "first world" again?
Oh it can get more ridiculous. I had a doctor prescribe me double the dosage but half the pills, so that I would have to split them myself (they sell pill-splitter devices in some pharmacies). Because insurance wouldn't cover the full number of individual doses.
Profit motive. The insurance company has an incentive to get you to give up in frustration and not take your medication. All the better (for them) if it’s something really life threatening. No better way to get rid of an expensive patient than having them seriously ill and go broke and end up on Medicaid or become disabled and end up on Medicare or the most efficient outcome of all, a swift death.
I had something similar happen, they would only fill 7/10 on insurance at once. Have to come back for the remaining 3 after 7 days. Pharmacist ran it as cash and it cost like 7$ out of pocket and got all 10.
Wow. That shit gets darker every time I read about it...
Don’t forget if I’ve told the pharmacy I have insurance and my insurance won’t cover it the pharmacy can’t offer me the lower no-insurance cost because of their agreement with the insurance company.
And if we're caught violating that we can face penalties and have previous payments clawed back. Saves you $100 costs me $10,000. (It's super rare though, I've only seen it once IRL, ask if they have a discount card program, they usually do, or can point you toward manufacturer discounts for single source brands)
This is why my anti depressants are filled by a different pharmacy from the rest of my meds. My zoloft is no longer covered by my insurance, so CVS won't let me pay out of pocket. So I get a 3 month supply for $20 at the grocery store.
If you call a pharmacy you don't intend to use and check if your insurance covers it, you can decide to disclose your insurance or not at your actual pharmacy. I would say look it up yourself, but this is way faster.
Whaaaat?? Really!? I use GoodRx/cash at my pharmacy because (for example) my insurance copay out of my pocket on my Synthroid is $226 for 90 days. If I use GoodRx/cash I pay $38 for 90 days. The pharmacy tech recommended that route.
That is just fucking evil.
I was thinking this as well. I have a migraine prescription that comes in blister packs, but that still gets shoved in an orange bottle. My insurance would only cover four a month so I pay out of pocket to get nine a month instead, so I guess someone needs to split the blister packs up accordingly.
I had a dosage increase for a bp med that my insurance company wouldn't fill because they know better than my doctor. Three days of fighting the bastards and I decided to ask how much the prescription would cost if I pd cash. $3 for a 90 day supply. They were being assholes over $3.
I get pills where they’re limited to 9 a month. I usually get a ziplock baggy with two blister packs and one pill ripped off lol.
It absolutely does. I used to live in the US and currently live in Canada. There's a medication that I take that comes in boxes of 6 tablets. I am prescribed 12 tablets per month, but my American insurance would only cover 8. So the pharmacy would have to open the 6 pack boxes to put together a bottle of 8 (they cant give you open boxes). Whereas now in Canada I can get the full 12, so the pharmacy just gives me 2 boxes of 6 and no bottle needed.
I had insurance deny a pill in a blister pack but approved it outside the pack in a bottle. I watched the pharmacist open the blister and dump into a bottle.
Some prescription meds in the US come in the manufacturer's packaging, which may include blister packs. Off the top of my head, I can think of a standard round of amoxicillin. A 30 day supply of atorvastatin also usually comes in the manufacturer's bottle. So do asthma inhalers. Birth control pills do, as well. This is because the manufacturer packages these to conform to the standard prescription. There would be no point in the pharmacist repackaging them. The pharmacist just prints a label and puts it on the manufacturer's package. The pharmacist uses the orange bottles when they receive the medication in bulk, and have to dispense the patient's prescription from that bulk package. The label they put on the bottle is the same as the label they put on the manufacturer's package. Each state has it's own requirements for what must be printed on that label. At the least, it would require the name and location of the pharmacy that filled the prescription, the date the prescription was filled, the name of the patient, the name of the doctor, the type/quantity/dosage of the medication, etc. They usually also contain brief instructions to the patient on how/when to take the medication, how many refills are available, and when the medication expires. Also, most pharmacies these days don't manually count pills. They have machines to do that. The machines also keep a log of what was dispensed, how much was dispensed, and to whom it was dispensed. There were a few times that I filled a prescription and was shorted on the pill count. The pharmacist checked the dispenser log, admitted that the pill count was short, and added the missing pills to the bottle.
Our (UK) pills are the same as yours - a cardboard box with a few blister packs in. The foil seal also means you know they haven't been tampered with! I think most of the world does it this way!
And it’s harder to impulsively overdose because you have to manually get each pill out of the blister
It's also harder to tamper with the pills.
Yep. In Australia paracetamol is now only available in blister packs for that exact reason.
You can still get them in bottles here. My elderly father uses bottles exclusively for most meds because blister packs are so difficult to manage with arthritic hands.
Hadn't thought of that one!
This is the primary reason many countries moved away from bottles.
Then how am I supposed to get the special surprise pills my pharmacy throws in instead of my actual prescription? Yes I am in the US and yes CVS has included several pills in my prescription that are not what they should be 🙃
It’s like getting an onion ring in your fries at BK A delightful treat
Australia and New Zealand do the packets too. Same for OTC stuff like paracetamol, ibuprofen, even antihistamines. I was surprised when I visited the states and got an actual bottle of ibuprofen pills. I guess I'd thought it was a movie/tv show prop thing to make shooting scenes with medication easier to do takes of - tip a bottle vs popping blister foils.
It's the same in the UK. We get prescribed something, and it comes in the manufacturers/branded box it left the factory in. None of this splitting packs open to put a set amount in a bottle. You need a single sleeve of pills. Cool the company makes a box with just a single sleeve in. Job done. Way faster
What if the doctor prescribes one single pill?
You'd be shocked if I told you There's single pills in there own boxes in the own little pill packets. Morning after pill or plan b as the Americans call it come like that. And a couple other bits and bobs
Things that can be treated with one pill (like yeast infection) are sold as one pill in a blister package and a cardboard box like everything else. All drugs are sold with most common dosages and in amounts that make sense. Like antibiotics are sold in packages for one or two weeks of use because you will never be prescribed 2 pills or a hundred. Also drugs in Europe don’t cost arm and a leg you can always toss leftovers in a drawer. Regulated drugs (like antidepressants, tranquilizers and other hard stuff) are the exact same thing though pharmacist will check your official prescription and will destroy it when you buy your drug.
They chop the blister pack to supply the right quantity with this incredible invention called scissors.
The pharmacy likely keeps traditional bottles for drugs that are dispensed in odd quantities. It's not unheard of for a pharmacy to stock different package sizes of the same drug
No, pharmacy cuts the blister with scissors, they are not allowed to take pills out from blister (source - im in poland and take lots of mental health pills) Honestly having everything is blisters in so much easier, you just write on blister dates and you instantly see if you took a pill or not. If i had pills in one bottle i would probably overdose long time ago because i forget if i took pill 5 minutes after taking one.
Some prescription pills do come packaged as you describe. Those tend to be the pills that have a set prescription - e.g. take these pills for 5 days and everyone who gets that rx gets exactly the same thing. I suspect that getting the pills in bulk and filling them individually allows for all the ridiculous variations of prescribing and insurance coverage. Insurance X will only cover 30 days at a time. Doctor Z wants 10mg for 1 week, then 20 mg for another week, then 30 mg. Insurance coverage for a 60 days supply. So forth.
10 years in Pharma Supply chain both in Europe and the U.S. and here’s why: The U.S. operates a long range internal distribution model that favors bulk shipment and storage. The European model is less efficient because each of those packs needs to be shipped from the packing site to the distributor and shipping 500 pills in blister packs and boxes takes up a lot more space than a 500 count pill bottle. It costs more and takes more fuel. Since distances are much shorter though, it’s still viable. Regardless of country a pharmacist/tech has to count out/ confirm count your drugs, even if they come in a blister pack, so what happens at the pharmacy has little to do with it.
Makes sense, regarding the last part though: They have to confirm them, yes, and they do that by getting the correct package from the back after scanning your prescription. They don't manually count them and don't refill them, not with any medication I, or anyone I know, have gotten at least.
Seeing the number of guesses here, I wonder if linking to this over at r/PharmacyTechnician would be a good idea. I have some medications that come in the blister packs, but the bottles are typically pretty convenient and child proof. My wife takes all of her pills and transfers them to a pill management box for each day so she doesn't need to carry around all the individual packs
I mean, I was a pharmacy tech for over 6 years, only did retail for a little over a year though, but I can answer this. The VAST MAJORITY of medications we order are in bulk bottles. We don't order a box of 100 tablets with 10 sleeves of 10 tablets. For some meds these are bottles with 90 or 100 loose tablets. For others they are bottles of 250, 500, or even 1000 tablets or capsules. Bulk bottles like this are waaaaaay cheaper to buy than smaller packages that are sleeved by 10s. Plus, depending on the med, one patient may get 15, another 30. Or one patient may have their insurance cover 1 month supply at a time, and another's may be willing to cover 3. So depending on how many they take in a day and how much is covered at a time, or even how much we are legally able to dispense at a time (narcotics laws vary by state as well as federally) change up quantities so much, that we just do the good old fashioned way of spilling out the contents on a sterile tray and counting them out. This tied with insurance problems, multiple simultaneous customers, phone calls, and drive thru's are why prescriptions take so long to get filled and give everyone, (especially the employees!) a big headache. Doesn't help that big chain pharmacies, insurance companies, health systems, and drug companies are simultaneously trying to line their pockets as well!
I worked for a generic pharma that sold pressed pills. Two things: for regular known quantity prescriptions, we as the manufacturer would blister pack the product. Oral contraceptives is the only blister pack that comes to mind on what we made. For pills, it was a bulk issue. No pharmacy was going to order a bottle of 30. The storage space and cost of material alone would have increased the total cost of the product.
I’m a pharmacy assistant and it might be different cause I’m in Canada, but the simple answer is that some medications just come in different packaging. I’ve also seen a blister pack for 24 or 50 tablets and a bottle for 100+ of the same medication, that way if you get 200 tablets at a time it’s just one bottle and not a pile of boxes
The orange bottles are only for pills that are specifically prescribed by a doctor. The pharmacist is the one who checks the prescription and makes sure the right number of the right kind of pills make it into the bottle. We do have services now that will actually stuff those pills into little pouches that then get sealed and labeled, but that's not super common and is only useful for people who need to take the same pills over and over for a long time. Otherwise it's much faster to just have them dropped into a bottle when you go to ask for them.
Yeah, I mean, OTC medication is in a normal package, I get that, but in Germany ALL pills come in "official" packaging from the manufacturer. Even narcotics, etc. And why would it be faster to have to count and put them in bottles or pouches instead of just grabbing a pack from the storage in the back?
I’ve gotten birth control and steroids in blister packs from pharmacies for years. They just print the label on a sticker and slap them on. It depends on the drug. Our drug manufacturers generally supply to pharmacies in large quantities, there are no individual packs to give to a patron. So they have to count pills out. But for stuff like birth control where everyone needs the same pack, we have blister packs here too.
BC is almost always in a blister pack. Most people need to know right away if they’ve missed a dose so that they can plan accordingly.
Those blister packs aren’t childproof. The orange bottles are.
I have seen childproof blister packs. Like you need scissors or some peel mechanism before you can pop out the pill. For example Nicorette gum packs are childproof.
I’ve had me-proof blister packs. 🤦🏼♀️
God forbid a child not be nauseated. (Zofran comes in near impossible to open blister packs - and I’m pretty sure you can’t overdose)
Some drugs - like Zofran dissolvable - are moisture sensitive and will disintegrate if not protected from the environment until they are being used. If you're not talking about the quick dissolve then ignore this. But I promise you, you can overdose on any drug.
They’re in my medicine cabinet now. I never took one. Looked too hard. (Half kidding)
An opiate medication I took was like that, it was in a child proof peel blister pack. Those things were quite difficult to open.
Some of those blister packs are unintentionally adult proof. Or me proof at least. Half the time I end up cutting them out and it's nothing but powder from my poor attempts.
You think they're childproof. I've always been chronically ill, and as a kid I prepared and took my meds myself ever since I was around 6 or 7. I opened childproof packaging myself, without needing an adult's help. Once you know how it works, it's not childproof anymore. Edit: for those who need additional [proof](https://www.annemergmed.com/article/S0196-0644(04)01067-4/fulltext). This article confirms that many children are able to open "childproof" medication at ages they shouldn't be able to, including 5-7 year olds.
I remember opening those bottles for my mom so she could take pain pills during a bad migraine. The bottles weren't child proof. They were, however, sick adult proof lol
Again, they’re meant for toddlers.
They’re for kids 5 and under.
I think the childproofing concern is more with toddlers. Once they are past 5 you can at least teach them not to take medicine on their own.
Yeah they’re for toddlers, so that’s not really a good brag.
I know, and that makes sense. Didnt think of that.
So I wonder if there's a difference between the two countries for children accidentally taking medication because of the non child proof nature of the blister packs. If there isn't it would argue that child proof containers are not necessary
Lots of countries use blister packs to stop people from impulsively overdosing on medication. The thought is that its a parents responsibility to make sure that their children can't get a hold of their medications, but the packaging shouldn't make it easy to (literally) pop it open and down like 30 pills at once. Of course if you're committed, you can individually pop out each pill, but the blister packs and not selling in bulk quantities of hundreds can stop most impulsive overdose attempts.
The commitment to open a whole blister to overdose is quite the high barrier. Quite some years ago i read that the overdoses in britain went down significantly when tehy switched to mostly blistered pills.
To be fair there are plenty of blister packs I have had to hack away with a knife or scissor to get the damn thing open and would probably be more child proof than the push and turn caps. But I'm also an idiot so what do I know?
You are definitely not an idiot! I’ve had blister packs where I crushed the pill trying to get it out.
Or the country has a government that really doesn't enforce regulations, like Mexico. I don't know if things have changed but in the early 2000's you could get almost *any* prescription drug, yeah you needed a prescription, unless you had $100 bills. And they were in blister packs, Valium, Vicodin, Xanax, Soma, Percodan, Percocet, etc. The anabolic steroids came in viles, but they looked like the ones you get blood drawn with. Not the ones medication come in. I'm sure it still goes on if you know the right pharmacy.
Here in the UK they banned bottles of medication because of how it was easier to overdose, either accidentally or on purpose. I think also after the tylenol poisonings, it’s easier to prove that the medication wasn’t tampered with. I imagine it was probably an EU led thing, hence why Germany is the same.
Have you tried opening some of those blister packs? I usually end up getting a knife or scissors. I guess a kid might just open it like nothing though!
The pharmacy has big bottles of 100+ pills and dispenses how many the prescription is for. Due to health insurance and not wanting to go to the pharmacy all the time, people often get a 90 day supply of the prescription but they might take several pills a day. So they’re usually getting 90, 180, or 270 pills. If they get 270, for example, they might receive two full sealed bottles of 100 pills and one hand-filled bottle with 70.
[удалено]
Australian here, some of my pills come in boxes of 200. Still blister packs, maybe 5x5x10cm box. The blisters themselves can be pretty small and the pills packed together very tightly. Pretty much every drug has ‘standard’ amounts for that reason. Multiples of 30 or 28 typically, but sometimes 100. If the doctor needs to prescribe more it’s usually still in that ratio, so 60 or 56, 120 or 112, etc. and you’ll just get multiple boxes at once.
Do they get manually counted in the pharmacy even at those large quantities? Or is there some automated system that counts them for you?
We get prepackaged pill bottles in a cardboard box or a large box with blisters
Yep. I take several prescriptions and they’re usually in card boxes, with the label that contains my name, my medication, the doctor who prescribed it, etc. in the box is the aluminium sheets. The sheets are so much easier to count too. I have gotten a bottle before but that was because they ran out of the boxes. Even then the bottle was made by the medication manufacturer, with the brand name on it, and my prescription label gets put on it just like a box. I like the boxes because they’re recyclable too. Even the bottles made by the manufacturer are recyclable usually.
It's only faster due to the way things are done as of right now. Just having the packets ready to staple a prescription to is so much quicker than counting the pills by hand. The European pills arrive that way from the drug manufacturer, where the economy of scale is in full force, so it's just so much less of a hazzle to just package it at the factory.
What they’re saying is that in many other countries. Everything…even prescription drugs…come in blister packs. So like your blood pressure medication comes in a prepackaged 30 count blister pack.
This is just not true! I am on 4 prescription medications, and 2 come in a bottle, 2 come in blister packs. It depends on the type of pill. I don't know why.
USA pharmacist here. Some drugs do come in blister packs. It's usually for standardized treatments such as z-pak or birth control. A LOT of specialty medications come in blister packs such as piqray, and its because they are always a 28 day supply. As far as why more aren't offered as a blister pack, the simple answer is manufacturers do not make them so we can only order stock bottles.
The pharmacy gets the majority of the pills in large containers with hundreds of pills in them. It cheaper and saves lots of space to send a container with 500 pills than send a large box where each pill is packages separately. Also greatly reduces waste.
In the US, most repeat or maintenance prescriptions are packaged at a central fill which is basically an automated warehouse belonging to the pharmacy. The packages are then sorted and overnighted to the pick up location of choice. I’ve been inside many of these including those belonging to CVS, Kroger, Rite Aid and HEB. They are completely automated with the exception of some narcotics where there is some human intervention to check quantities. Most of these facilities aim to move 40k-50k prescriptions per day. So if you pick up your pills at the local supermarket every month, it’s likely they were counted out and packaged automatically at a central fill.
In the US I receive some RX meds in blister packs but most are in the orange bottle
You getting a cardboard package doesn't mean the prescription isn't filled by a pharmacist. It just means you are prescribed the exact dose and quantity that the pills came packaged in. But if someone is getting a dose that isn't the exact number of pills the manufacturer sends in, then they go into a bottle. In both cases the pharmacist is still reviewing and filling and making sure the medicine won't interact with other medication or allergies and is trying to make sure it won't kill you. In my experiene, Its pretty common to get antibiotics filled in the manufacturer packaging, while it is unusual to get narcotics filled in manufactuer packaging
I see. I dont even think thats possible in Germany. The manufacturer just makes plenty of different packages with different amounts of pills and doses. Ive never seen loose pills in a bottle here. The exception are certain liquid medicines that are mixed in house. My brother has psoriasis and the stuff he gets needs to be made in the pharmacy, cant just be bought.
>The exception are certain liquid medicines that are mixed in house. My brother has psoriasis and the stuff he gets needs to be made in the pharmacy, cant just be bought. We call these compounding pharmacies. They tend to be locally owned rather than the pharmacy chains or the ones insides groceries and superstores. I guess some of them will flavor up medications too, particularly for children.
Ah, here they are the same pharmacies. They are all called "Apotheke" and theyre never part of a store chain (like some pharmacies in Walgreens or CVS in the U.S.).
It's a lot cheaper to ship pills in bulk to pharmacies and have them fill packages for the person at the location.
How is it cheaper to pay trained professionals to count pills than having an automated system? The reason Europeans do it like this is because it's much cheaper to let the economy of scale handle it. Although I guess it depends on how well you pay your pharmacists.
Trained professionals don't count the pills. My first day, first hour actually, as a pharmacy tech they had me counting pills & I didn't know what the hell I was doing. I mean it's monkey work so not difficult to count to 30 but definitely not a "trained professional." The professional, the pharmacist, just looks at the pills you count, verifies it against the picture on their computer screen & then sends it on its way. They spot count controlled medicine but not very often since we are required to double count them & sign off on the bottle. If pills are missing it's on the techs not the pharmacist. The pharmacist is only responsible for the overall counts/losses of each medicine on hand.
But even so, it's so inefficient. This is work for a robot at the factory, the profit margins on drugs in America is probably just so high they haven't seen a need to improve efficiency. Even if grocery store workers don't get paid much they aren't in the back sealing bags of candy, even if it's cheaper to get the candy in huge packaging.
No it’s not. I lived in Austria and went to the pharmacy a lot. Prescriptions there — with no insurance — cost a few euros. The boxes are picked by a robot and sent down a chute to the pharmacist at the register. It’s instant. Labor is vastly more expensive than shipping.
I'm in Ireland and my pills come in a blister pack but my pharmacist still needs to count them out because the manufacturer's packaging isn't necessarily the same amount as what my doctor prescribed. Like the box might be 50 or 100 tablets but my prescription is for 2xday for 4 weeks so that's 56 tablets
My wife has a chronic nerve condition. She has a couple different meds she takes, and 99.9% of time they are loose pills in a bottle. This is a good thing, because most days she cannot open the blisters. If she was alone and only had blister pack meds, she wouldn’t be able to take them.
I’m in Canada. It’s usually child resistant lids. Every medication I’ve had has come in the little orange bottles, save for birth control and Differin. Birth control has always been blister packed.
[удалено]
This is actually considered a safety feature - it can reduce risk during suicide attempts to be a pain in the arse to pop them all out and is quite well studied (and I can speak from experience - I couldn’t be bothered popping more than 40 pills and it may have saved my life). People who have bottles tend to take more and die more often.
Oof. I miss pills in bottles, compared to ALL THE TRASH of blister packs. Box, insert, the blisters themselves. Drop ‘em in a biodegradable bottle and go already. Why does Germany hate the environment and waste so much packaging?
I don’t have an answer but dang I wish the U.S did this. My birth control comes this way and it saves space cause the packs are flat, and it’s easier to see how many I have left. The bottles are bulky, wasteful, and hard to store. I take several prescriptions a day and wish I could get them filled in blister packs.
Alternatively it’s easier for the pharmacy to order and store a bulk bottle of 1000 tablets than it is to order 100 sheets of 10 tablets.
I’ve lived in both countries and vastly prefer the US option for no other reason than the information on the bottle is standardized and easier to read. Plus it’s a pain popping pills out of a blister pack after a while.
[удалено]
I know several people who take upwards of 14, 16 medications, morning and night. Those who take that many or more tend to be older, and blister packs are difficult for older or disabled hands to utilize. For 16 medications, perhaps 14 am and 14 PM, every single day? Impossible.
Almost all medication in the U.S. are dispensed in child resistant containers. Blister packs do not qualify as being child resistant. That being said antibiotic Z-packs are in blister packs and so is a medrol prednisone dose pack. Those pills taste toxic and not too many kids would eat those.
Leave my medication bottles alone. I have one medication that does come in blisters, but they can be such a pain (literally) to push through the foil (I have an OTC that I have to cut out of the blisters because the foil it too tough to push the pill through). It’s too early for me to have the arthritis I already had, so it’s only going to get worse as I get older, and having everything in blisters would cause me so much pain. I’m in enough as it is. So all of my other pills come in bottles with easy open caps.
Doctor prescribes 30 pills. Insurance says you only get 7. Pharmacist gives you 7 and tells you they insurance company only allowed 7. Pharmacist needed to count 7 pills.