When Less is More: How Packaging Redesign Serves Our Patients and the Planet

What’s more, one of the newly designed kits will enable us to stack up to almost 180% more product on a standard shipping pallet than before, which means we can include more product in a single shipment and our specialty pharmacy (SP) distributors will be able to store more inventory on their shelves – reducing emissions associated with transportation and better serving patient needs.

This article outlines the steps Todd and Katie, with support from a cross-functional team, took to redesign United Therapeutics’ Tyvaso packaging kits, the outcomes of this work, and some lessons learned. But first, let’s begin with an overview of what sustainable packaging means.

What is sustainable packaging?

Developing more sustainable packaging entails designing, manufacturing, and using packaging in ways that deliver product in the expected condition while reducing the overall environmental impacts of the packaging itself.

There are multiple pathways available to incorporate sustainability into packaging design. Here are four guideposts organizations often use to frame their thinking:

1. Define your scope:

Consider what level of packaging is in scope for your packaging redesign. Product packaging has three levels – primary, secondary, and tertiary. Primary packaging touches the product most directly. So, for example, pharmaceutical product often is in a bottle that is inside a box; the primary packaging is the bottle. In the pharmaceutical industry, primary packaging is highly regulated, requiring intensive testing documentation and often lengthy approval processes, which makes it more challenging to redesign than other packaging levels.

Secondary packaging is generally used to group components of the product and is a vehicle for product branding. In our example, the outer box would be considered secondary packaging.

Finally, tertiary packaging is often called bulk packaging or transit packaging used to ship a set number of a product to a distributor, such as a specialty pharmacy.

2. Use less:

As consumers, we’ve all experienced what is called material “lightweighting” – think of a typical single serving bottled water you can inadvertently crush in one hand. Simply using less of the same material can have environmental benefits. First, you conserve resources necessary for the package itself. Second, lighter goods weigh less, which means they use less fuel to transport. But lightweighting is not the right decision for every product. Designers must balance the suitability of a package to protect the product inside against the drive to use less material. After all, spilling some water by accident when you squeeze a very lightweight water bottle a little too hard is one thing; missing a critical dose of medicine because the packaging was too fragile for transit is quite another!

3. Choose the right materials:

Selecting packaging materials that include recycled content or that can easily be recycled, compostable where appropriate to their function and likely disposal, or, if using virgin paper-based materials, certified to sustainability standards like the Forest Stewardship Council (FSC), are some ways to address the environmental impacts of packaging. For example, using paper derived from timber from forests that are certified as being managed in ways that protect habitats, prevent pollution, and that plant more trees than are harvested, can have a multitude of other environmental benefits.¹

4. Analyze your packaging footprint:

To deliver effectively on sustainable packaging goals, designers need to think about materials used and their full environmental impact across their lifecycle – from raw material extraction to end-of-life, recycling, or reuse. Using third-party life cycle assessment (LCA) tools can provide systematic and quantitative assessments of various environmental factors across that lifecycle of a material based on underlying analysis of similar materials and products.

The United Therapeutics team considered these guidelines when redesigning the packaging platforms for our Tyvaso product.

the united therapeutics Challenge

We distribute our Tyvaso Inhalation Solution in three different kits:

• A Patient Starter Kit (PSK) is the first package patients receive when prescribed nebulized Tyvaso. It comes with everything the patient needs to get started – a month’s supply of medicine, two nebulizer devices, medicine cups, instruction manuals, and more
• An Institutional Starter Kit (ISK) is for patients prescribed nebulized Tyvaso that are in a hospital setting and includes everything that is provided in the Patient Starter Kit, but only a one-day supply of the medicine
• A Refill Supply Kit (RSK) is what we send to patients every month with supplies of the consumables components patients need to continue their therapy

Tyvaso Inhaled Solution is also available as the “Tyvaso 4 Pack Carton”, which is a small carton containing a one-day supply of medicine.

If a patient needs a replacement device for whatever reason – at the end of its effective use period, or if a device malfunctions and can no longer be used – then a Single Device Kit (SDK) is provided to ensure that a patient has a back-up device available.

The recent packaging project was prompted by feedback from several stakeholders. “Our warehouse team could see that we were shipping a lot of air,” said Matthew Taylor, Senior Director, Materials Management, Manufacturing. “The reduction in the size of our packaging will help significantly in our ability to decrease the overall footprint required for warehouse storage and decrease the number of trucks we need to ship product.”

Our SP distributors noticed the same. “SPs have limited space for inventory,” explained Chip Jackson, VP of Distribution and Patient Access, Strategic Operations. “This forces them to order a lower volume more frequently to ensure adequate inventory to meet patient demands…. Our patients are also often on multiple therapies. The SPs may ship the UT product along with others in a single shipping container. Reducing the size of our packaging can enable them to use a smaller size shipping container. It helps everyone.”

Patient experiences factored heavily in the team’s thinking. Some patients found the PSK difficult to handle because of the size and weight of the boxes, and others felt guilty about the amount of waste they generate from these deliveries. Patients care about the environment, too!

These inputs fueled the team’s journey to the launch of its new packaging systems, expected in 2024.

Step-by-Step Process

Following the guideposts listed above, Todd and Katie literally unpacked each kit, seeking to address the following:

• Size and weight reduction potential
• Packing efficiency
• Waste generation for patients

They convened meetings across internal stakeholders representing the patient experience, strategic operations, marketing, quality, warehouse, regulatory requirements, and SPs, covering everything from the package components to the labels. This resulted in several key insights and decisions.

Working with their packaging vendor, they determined that smaller boxes for the secondary and tertiary levels could be used simply by packing components differently, thus saving space. They also realized they could do even more if they reconfigured one of the chief space consumers in their kits – the medicine cups.

Patients receive 32 disposable plastic medicine cups with each PSK or RSK. Medicine cups arrive empty in 16 individual molded plastic holders per tray, with a tamper proof seal that patients need to remove to access each cup. While the medicine cups are not shipped with pharmaceutical product in them, they are used in the nebulizer to hold medicine. That means the medicine cup material is closer to primary type than the other packaging components. “The medicine cup seal is challenging for many of our patients,” Todd explained. “So, we worked with our vendor to replace the trays with a single cylindrical canister made of the same material as the molded tray plastic. That way, we did not have to go back for biocompatibility testing of the material itself.” All of this resulted in a compact container that is 80% smaller than the original trays. This, in turn, enabled the team to reduce the size of the secondary and tertiary boxes even more.

With these improvements, they achieved multiple business benefits:

• 36% reduction in material use and a 54% volume reduction for the PSK
• 73% reduction in material use 70% volume reduction for the RSK
• Room for almost 50% more PSKs on a pallet, and almost 180% more RSKs on a pallet
• 65% less plastic per shipment of each kit

But, that’s not all.

The team redesigned the labelling approach, choosing to preprint the labels on the PSK and RSK outer boxes, reducing cost, labor, and waste. What’s more, they eliminated unnecessary spare components in the SDK, which enabled the team to create a thoughtful design that delivers only what the patient needs: a device, a wall plug, and an Instructions manual.

All of this has important climate-related benefits as well. According to an LCA analysis based on annual usage rates, these improvements taken together will help avoid more than 200 tons of GHG emissions representing up to an 80% improvement in GHG emissions over the original packaging. On top of that, the packaging avoids using 19.3 million gallons of water and more than 300 barrels of oil associated with plastic production.

Lessons Learned

“Everyone was eager to see the changes come to fruition,” Todd said. Yet, the path forward was not exactly linear. “Updating the labels [now printed on the PSK and RSK] took many review cycles to make sure they met requirements of all our internal stakeholder groups while complying with our labelling and control requirements,” Katie said.

There are also multiple considerations the team had planned for, and others they discovered along the way, that extended their original timelines. “Changes to anything our patients touch, like the medicine cup packaging, requires close attention,” Todd explained. “We have documents that categorize the risk of several aspects of the design and useability of the packaging components. Any time we change one of those designs or functions, we need to ensure we aren’t increasing risk to the patient. [That’s why] we performed human factors testing to ensure patients were able to easily interact with the new canister and the stack of medicine cups.”

The team also needed to make sure they conducted transit studies to ensure that the newly-efficient packaging performed under potentially stressful transit conditions, like packaging mishandling, adverse weather conditions, and more.

Finally, the team needed to update documentation – lots of documentation – in house and alongside contract manufacturing partners to make sure all team members understand the new design and pack it carefully and in the right orientation and sequence to make best use of the redesigned containers.

What’s Next?

Overall, was it worth the effort? “Yes,” both Todd and Katie say. As a public benefit corporation this effort is firmly in line with our commitment to address patients’ unserved needs while operating sustainably. And, although the project took longer than expected, “if you partner with sustainable packaging experts, as we did with our packaging vendor which helped us complete the LCA analysis, you will find improvement opportunities,” they explained. In addition, the project will result in packaging material cost savings from 7% to 70% depending on the kit, and the team anticipates additional cost savings related to transportation and vendor costs. For example, the packaging redesign helps eliminate the need for a step in the supply chain for the SDK, resulting in multiple cost benefits.

Todd and Katie hope this project will inspire others inside United Therapeutics, and possibly some of our business partners and industry peers, to explore opportunities to improve packaging.

UN Sustainable Development Goals

This project aligns with multiple UN Sustainable Development Goals, but especially UN SDG 3 – Good Health and Wellbeing and UN SDG 12 – Responsible Consumption and Production.

¹ https://us.fsc.org/en-us/what-we-do/advantages-of-fsc