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Can Your Medicine Bottles Do This?

by B. T. Kimbrough and Marja Byers

Doctor's Orders

Those of us with limited vision often find ways to harvest the information from food and over-the-counter medicine labels when we really need to. Many of those ways involve help from sighted family members, friends or neighbors. But what happens when our packages contain prescription medication and arrive with customized print instructions that we would prefer to read for ourselves--without necessarily sharing the information with anyone else?

If lack of privacy is the most significant disadvantage associated with blindness or low vision--and many of us believe that it is--the difficulty of getting private information about our prescription medications is long overdue for attention.

The United States Congress took a step toward addressing this problem a year ago when it passed the FDA (Food and Drug Administration) Safety and Innovation Act, which is scheduled to go into effect on the first day of 2015. The law requires that blind and low-vision patients must receive instructions they can read for themselves when they buy prescription medications either directly or via mail order.

The legislation itself did not stipulate what does or does not constitute an accessible format. That issue was left with the US Access Board, which held a series of meetings last year with interested parties, including consumers and major players in national pharmaceutical sales, such as Walgreen's, Walmart and CVS. The Access Board produced a set of guidelines, or "best practices," designed to serve as blueprints for actual accessible solutions that pharmacies can offer to blind and low-vision customers.

Now, as days grow short before the new law takes effect, there are actually three accessibility solutions available to drugstores and pharmacies in the US. This article will provide some details about these products, the available information about what retail pharmacy is offering them, and how they can be obtained.

NOTE: The overall plan calls for print enlargement solutions as well as audible ones, but these will involve more adjustments to current labeling practices than development of new labeling products. This article will focus on new alternative labeling solutions which have actually achieved product status.

What Goes On the Bottle

Talking Pill Reminder is the accessibility solution offered by Walgreen's drugstores. It's a plastic disc about an inch across and about three quarters of an inch thick and comes with adhesive stickers to secure it to the bottom of a prescription medicine bottle. It has two buttons. The control marked with one dot is for playing and recording information with a maximum of 30 seconds of recording time. The button marked with two dots sets a beeping reminder in adjustable intervals from two to 24 hours. Talking Pill Reminder is the only product in the field so far that involves voice recording of information.

Once the order is prepared, the pharmacist would record all of the needed instructions which would fit in the 30-second window, and then attach the device to the bottle before shipment. Operating instructions are provided in both braille and print. The Talking Pill Reminder can be included at no charge for medication orders over $25; for smaller orders, the device costs $9.99.

A company called AccessaMed offers the Digital Audio Label, which is designed to be permanently attached to the medication bottle with a hyper-strength sealant. Participating pharmacies will obtain a special docking station for about $20 which connects to the store's label-generating computer. At the pharmacist's option, text from the finished label will be sent to the Digital Audio Label and converted into an audio file using a synthetic voice which has been licensed from AT&T. The pharmacist can use check boxes in the software to control the speed at which the text will be spoken and whether any of the words will be spelled as well as pronounced. The labels reportedly cost the retailer about $3 apiece. It is expected that participating pharmacies will offer the disposable Digital Audio Label at no extra charge with the walk-in or mail order purchase of subscription medication.

The developer with the most experience in this area is Envision America, which has offered a medication accessibility solution for at least ten years. The heart of the Envision America system is a computer application which converts a finished print prescription label into an electronic file which can be stored in an area of a few centimeters. The stored file is conventional electronic text decoded by a product called ScripTalk Station, which is designed for long-term, no-cost loan to the blind or low-vision consumer. The retrieval technology uses a weak radio signal or RFID to transmit the data once the ScripTalk Station is placed on top of the bottle whose label contains the RFID code. Participating pharmacies pay about one dollar for each disposable "talking" label, though the start-up costs are reported to be close to a thousand dollars.

Those Devilish Details

The ScripTalk Station is the only device in this group to offer volume adjustment and an earphone connector for private listening. None of the products offer the user the option to control the speed of playback or to scroll back and forth within the information. All three offer a simple start/stop control which is combined on a single button. Talking Pill Reminder stands alone in offering an alarm to help with multiple doses that need to be spaced within a single day. ScripTalk Station is the only product to offer data retrieval in multiple media. Because the electronic text stored in the RFID can be transmitted to a computer, it can be displayed in hard copy or refreshable braille, which would be essential if the user is deaf-blind.

The Talking Reminder is unique in that it is reusable. Once the original medication is gone, the reminder could be detached from the bottle and associated with other medications so long as there is someone available to record the essential information. The recording and speaker are of marginal quality, but with a little care and adaptability, a serviceable recording could be made to supply necessary information when it's time to take the medicine and no sighted help is available.

Your Mileage May Vary

You know those phrases of disclaimer that come at the end of radio commercials--"Some assembly required. Sorry, Tennessee!"--well, there are quite a few special circumstances to bear in mind when shopping for medication that you will be able to handle independently. For openers, we don't know of any pharmacy that offers multiple accessible solutions. The alternative is to learn something about every accessible solution and then find out which one your store of choice offers. If their solution doesn't appeal, you might decide to go for a pharmacy that offers a solution you prefer.

Some outlets may offer no solution at all, in which case they are in technical violation of the new law as of January 2015. Bring that matter to the attention of management, and do not hesitate to talk up the accessible solution that sounds the best to you.

What We Know So Far

Walgreen's (over 8,600 stores in all 50 US states) has an exclusive relationship with the source of Talking Pill Reminder. If you are arranging for a mail order, there is a phone number you need to use to ask for the Talking Reminder at the time you order your medicine. The number is 800-345-1985; ask to speak to a customer advocate. If you are a walk-in Walgreen's customer, contact the store pharmacy manager to find out if there are any Talking Pill Reminders in the store. When we checked, many local stores had at least one of the units, and their managers were aware of the product's purpose, but a few stores were out of the loop, so to speak, and their managers only caught up when we brought the issue to their attention.

The Digital Audio Label had not been officially adopted by any national providers by press time. There was some talk of a pilot program among some Target outlets, so you might check with your local Target manager if you are interested in the Digital Audio Label. For later information about pharmacies that use the Digital Audio Label, contact Chad Hazen of AccessaMed at 360-773-0060.

The ScripTalk Station is offered for mail orders through CVS Pharmacy and Walmart. There may be some local in-store availability, so check with the local pharmacy manager at your nearest CVS or Walmart. You will need to arrange with Envision America for the free loan of a ScripTalk Station. The toll-free number to do that is 855-773-2579. That same number should yield information about how you could arrange for CVS or Walmart mail orders in conjunction with the ScripTalk hardware and labels.

Whichever numbers you call, be prepared for the possibility that you'll be asked for documentation of need, that is to say, written proof of limited sight. Those with a handy copy of a "limited vision" statement from a doctor or even a well known agency in the field may get a quick pass, depending on how motivated the gatekeepers are to hold down demand for the new accessible solutions. Surely, over time, the process of proving need will become routine and standardized as corporate executives come to realize that checking credentials costs money, while selling accessible medicines generates revenue.

Bottom Line

The bad news is that the current situation in accessible medication labels is a jumble of complexity and rapidly changing restrictions/opportunities. The good news is that the new legal mandate offers a financial motive to providers that will, one day, open a new window of opportunity for consumers to read the label as easily as they can locate the bottle itself.

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