From the U.S. Government Accountability Office, www.gao.gov Transcript for: Prescription Drug Labeling for Individuals Who are Blind or Visually Impaired Description: Audio interview by GAO staff with John Dicken, Director, Health Care Related GAO Work: GAO-17-115: Prescription Drug Labels: Actions Needed to Increase Awareness of Best Practices for Accessible Labels for Individuals Who Are Blind or Visually Impaired. Released: December 2016 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's December 2016. About 7.4 million Americans are blind or visually impaired, and they may have trouble reading the labels on prescription drug containers. Accessible labels, which include audible, Braille, and large-print labels, can help. A 2012 law required that federal agencies develop best practices for making labels accessible. A team led by John Dicken, a director in GAO's Health Care team, recently reviewed how pharmacies have implemented these best practices. Jacques Arsenault sat down with John to talk about what they found. [ Jacques Arsenault: ] Drug instructions are pretty important; do pharmacies generally provide accessible prescription labels for people who are blind or visually impaired? [ John Dicken: ] Well, what we found is that pharmacies have the ability in many cases to provide the labels, but very often they are not dispensing labels that have large print, or Braille, or audible formats that could be more accessible. When we looked at it, we found that many chain drug stores and pharmacy benefit managers that may operate mail order pharmacies do have some of these technologies available, but only a very tiny fraction of prescriptions dispensed are with those accessible labels. [ Jacques Arsenault: ] And about how many prescriptions come with accessible labels? [ John Dicken: ] Yeah, when we talked to some of the large chain drug stores, they may dispense several million prescriptions during a quarter and only a few hundred or few thousand may be accessible labels in the formats of large print, or Braille, or audible. [ Jacques Arsenault: ] That definitely seems like a small number, especially thinking about almost 7 and a half million Americans that have some visual impairment. [ John Dicken: ] Yeah, it's much smaller than the population that may have visual impairments that may have trouble reading the small print on drug labels. [ Jacques Arsenault: ] So, what are some of the barriers for making these labels more accessible? [ John Dicken: ] Well, for the pharmacies themselves, there are issues that they're not typically reimbursed for the labels. So, with a low demand, they may be facing some cost for producing the labels. There's some technical challenges-that very small space on a drug container label-and so that there's not a lot of space for large print or for installing some type of audible label. And then just lot of lack of awareness by the pharmacies or by consumers that these technologies may exist that do allow them to put this information onto a drug container label. [ Jacques Arsenault: ] So then does the federal government have a role in making these accessible labels more accessible? [ John Dicken: ] Yeah. While the actual content of drug labels is subject to both federal and state regulation, there really aren't any requirements that they be made accessible. But there was a requirement that Congress asked the US Access Board, which focuses on access to individuals with disabilities, to come up with some best practices. And they issued those best practices for accessible drug labels back in 2013. They also required the National Council on Disability to do outreach to pharmacies about these best practices. [ Jacques Arsenault: ] So let me ask you, then, what are the things that somebody's facing if they are blind or visually impaired and they don't know about or don't have access to these accessible labels? [ John Dicken: ] Well, certainly the labels have very important information for individuals to know the drug information so they can safely take this, take the drugs. So some individuals may either not be able to read that information, they may use ad hoc measures like putting rubber bands on drug label to recognize what it is. But those really aren't reliable for individuals to be able to have the full range of information that is required to be on a drug label. So really not knowing, on one hand, whether these technologies for more accessible labels exist; not knowing whether the pharmacies that they go to, whether they provide the type of accessible label they're interested in; as well as that, even if an individual is aware of these technologies, the pharmacy may not always be able to provide it that same day. So they may be able to get drugs within a few days through mail order or central distribution, but drugs are needed the same day. Sometimes pharmacies are not able to meet those requests with accessible labels. [ Jacques Arsenault: ] Can you talk about the recommendations that GAO's making, then, in this report? [ John Dicken: ] Yeah. So GAO has recommended that the National Council of Disability, which was required under law to do outreach, extend those efforts. That back in 2013, 2014, they took some limited steps in doing some social media and press releases, but did very little since that time. And so we have recommended that the National Council of Disability assign key responsibilities for making sure that further outreach is done and to try to evaluate with stakeholders, such as pharmacies and consumer groups, to make sure that outreach is effective. [ Jacques Arsenault: ] So finally, for patients, pharmacies, and the federal government, what would you say is the bottom line of this report? [ John Dicken: ] Well, really, for individuals, it's very important to be able to have drug labels-they know the information, they know what the dosage is. And so to be able to go and ask pharmacies whether they can provide accessible labels. Because these technologies do exist, individuals asking may be able to find that their pharmacies can provide it. Or if not, can go to other options, such as mail order. For the pharmacies themselves, being aware of the best practices, to try to make the information available in the best possible format is really important. And then, really want the federal government through the National Council of Disability to continue to provide outreach to make sure that pharmacies and individuals are aware of these options. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.