Pharmacy and the Visually Impaired

How would it affect your outcome of therapy if, when you went to the pharmacy to pick up your prescription, after you were consulted, you were handed a bottle full of pills with no label.  If that was your only prescription you might be able to manage; however, once you got home you set your prescription down on the table and you have eight other prescription bottles, all without labels, it might become an issue!  This is essentially what happens when a visually impaired individual receives a prescription.

Years ago, when I was a young pharmacist a few years out of school, I would regularly help my mom set up her medications in a pill box.  We would then make sure her "as needed" medications were close by and lined up in a specific manner so it would be simple and easy for her to locate what she needed when she needed them.

Due to Mom's medical condition, she took an anti-diarrheal medication on a fairly regular basis.  This medication decreases propulsion through the GI tract and can quite significantly slow diarrhea.  One morning this was a particular issue.  Mom had taken one of these tablets every 2 or 3 hours throughout the morning and afternoon.  By evening, the diarrhea had not decreased, and she was getting very short of breath and gurgling in her chest.

Here’s the deal, Mom was so familiar with how her tablets felt, she was sure she was taking the correct medication.  The bottles were the same size and the tablets felt similar.  She had not been looking at the label.  Mom was not blind; however, she didn’t have the greatest eyesight.  Evidently, she had been taking her heart medication tablets all morning and afternoon. 

This overdose significantly decreased her heart function and allowed for a backup of fluid.  Mom was quite weak already, so this didn’t help matters much.  She was admitted to the hospital, stabilized, then came home and passed a couple days later comfortably in her own bed.

Mom was hip, smart, and knew why she was taking each and every medication.  One would not expect that she would have mistakenly taken the wrong medication. 

It is difficult to imagine how an elderly patient, living on their own, who is prone to slight confusion, and some level of visual impairment, can manage their medications without some help. 

In 2012, the President of the United States signed into law the Food and Drug Administration (FDA) Safety and Innovation Act (s.3187), requiring pharmacies to provide accessible prescription drug labeling for the blind, low vision and seniors. Under Section 904 of the Act, the U.S. Access Board, comprised of representatives of the visually impaired community as well as large pharmaceutical companies, were tasked to determine the best practices for accessible prescription drug container labels. In developing the best practices, the Access Board confirmed the use of braille, auditory means and enhanced visual means.

Their goal was to create and publish best practices guidelines for accessible prescription drug container labels, including "guidance to pharmacies on how to provide accessible prescription drug container labels to patients with visual impairments to enable them to manage their medications independently and privately, and have the confidence that they are taking their medications safely, securely, and as prescribed."

The completed best practices guidelines were published in July of 2013.  Currently, these best practices guidelines are just that, guidelines without regulatory enforcement or penalties for non-compliance; however, after 18 months, beginning January, 2015, the Government Accountability Office will begin monitoring how well pharmacies are participating in these guidelines and require that barriers to access are addressed.

Currently, two different companies are in the business of providing label reader options for the visually impaired.  Each has a different mechanism for providing the prescription label information to the visually impaired consumer; however, they utilize differing technologies.  You may review them yourself here:

Back in the early 90's, if my mother would have had ACCESS to a Prescription Label Reader, I am sure she would have avoided treating her diarrhea with her heart medication. 

Of course, in addition to the prescription label, patients are also handed a plethora of written Patient Medication Information.  As an alternative to the written PMI, consumers may visit and LISTEN to their medication information. 

If you or your family members are visually impaired, please ask your pharmacist for an accessible prescription label.


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