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President Donald Trump has also signaled a desire to bring manufacturing jobs back to the USA. That could mean domestic production of active pharmaceutical ingredients (APIs) will increase in the next 4 years. It could also mean changes at pharmaceutical companies that outsource packaging and many other functions. Will the current model survive as is? Instead of trying to predict exactly what will change, this article makes the case for a new approach to pharma- ceutical packaging. The logic of upgrading how we pack- age pharmaceuticals is obvious, especially in the treat- ment of chronic diseases. Ripe for change Changing how we treat chronic disease offers the biggest opportunity to reduce the cost of healthcare. Figure 1 ranks the prevalence of different chronic condi- tions, and figures 2 and 3 show how many suffer from multiple chronic conditions. In 2010, 86 percent of all healthcare spending was directed to patients with one or more chronic conditions, and 71 percent of all spending went to people with multiple chronic conditions [1]. We spend more treating these diseases than we do any other area of healthcare delivery. The problem in treating peo- ple with these conditions is twofold: The cost of the drugs and getting people to take them as directed. Cost. For many people. filling their prescription is expensive, and many must decide between paying for medications or other necessities. As patients will readily admit, many do not take their medications as prescribed and/or skip getting refills because of cost. Adherence. Also known as compliance, adherence refers to how well patients follow the prescribed regimen of treatment. Adherence minimizes the effects of chronic conditions. More than half the population, 51.7 percent, has a chronic condition, and it's not restricted to the elderly, although they account for more of these conditions. Women are more likely to report multiple chronic condi- tions than men (34.7 percent versus 28.2 percent). Approximately 80 percent of people 65 and older have chronic conditions, and people in that age group account for a bigger share of total US spending on healthcare 12 May 2017 Tablets & Capsules Figure 3 Percentage of Americans with chronic conditions by number of chronic conditions in 2010 Percentage of Americans Number of chronic conditions 0 CC 1 CC 2 CC 3 CC 4 CC 5+ CC 60% 40% 20% 0% Figure 2 Percentage of all Americans with multiple chronic conditions 31.5% have multiple chronic conditions Figure 5 Total US healthcare spending by number of chronic conditions in 2010 14.8% for persons with 1 chronic conditions 14.2% for persons with no chronic conditions 35.0% for persons with more than 5 chronic conditions 11.2% for persons with 4 chronic conditions 13.0% for persons with 2 chronic conditions 11.8% for persons with 3 chronic conditions Figure 4 Percentage of all Americans with multiple chronic conditions by age group in 2010 Percentage of Americans Age range 0-17 18-44 45-64 65+ 100% 80% 60% 40% 20% 0% 48.3% 6.8% 18.0% 49.1% 80.1% 20.2% 11.0% 7.0% 5.0% 8.7%