Expanding Access to Care: Implementation of an Audible Prescription Labeling System (APLS) at Johns Hopkins Community Pharmacies

Written by Ally Rhea, PharmD Candidate 2027; Sai Wright, PharmD, MBA, MSPH; Laurel Uhomba, PharmD, MBA, MPH

Nearly 12 million adults over the age of 40 in the United States are living with vision loss, which may significantly impact their ability to manage medications safely.(1) Prescription labels are often printed in small fonts that are not accessible to visually impaired individuals. Without the ability to read medication names, instructions, or warnings, patients may face increased risks of medication errors, reduced medication adherence, and adverse health outcomes.(2)

To address these challenges, the Maryland General Assembly passed House Bill 456, which mandates that pharmacies adopt regulations necessary to ensure that individuals who are blind, visually impaired, or otherwise print-disabled have appropriate access to accessible prescription labels.(3) The legislation does not mandate the use of a specific format or technology; therefore, pharmacies have flexibility in how they meet the accessibility needs of the patient population.

In alignment with these requirements and in recognition of the need to improve medication access for visually impaired patients, a Johns Hopkins Community Pharmacy, in collaboration with the Johns Hopkins Wilmer Eye Institute launched an Audible Prescription Labeling System (APLS) in July 2024. The goal of this service is to improve medication safety and autonomy for patients who are visually impaired by providing prescription information in an audio format.

The APLS enables patients to access audible prescription information through Radio Frequency Identification (RFID) technology. A small RFID label is programmed by a pharmacist and attached to the prescription bottle. The RFID label can be scanned using a free mobile app or handheld reader device which allows the patient to hear information such as the medication name, instructions, warnings, prescribing provider, and fill date read out loud. This service is offered at no cost to patients and can support 25 languages. Patients can join the program through walk-in requests, the emergency department, or provider referrals. To help patients and caregivers learn about the service, informational flyers and signage are available in the pharmacy. In collaboration with the Wilmer Eye Institute, the pharmacy developed high-contrast black-and-white signage to improve readability for individuals with low vision. Many patients also hear about the service through referrals and recommendations from pharmacy staff and providers at the Wilmer Eye Institute.

Figure 1. Handheld Reader for APLS Technology

Once a patient is identified, an “FYI” flag is added to the patient’s medication profile, which triggers a flag notification in the pharmacy dispensing system to alert staff. Next, pharmacy technicians fill the prescription and the verifying pharmacist programs the RFID label before final verification. Pharmacists counsel enrolled patients through demonstrating how to use the APLS reader device or mobile app. For clinical management, the Home-Based Medication Management team contacts the patient within 72 hours to ensure the label is functioning correctly and to provide any additional support needs.

Since implementation, 30 patients total have enrolled in the APLS within the first year of the service. Thirteen patients (43%) were referred by providers or the Wilmer Eye Institute, while 17 patients (57%) enrolled through walk-in requests. Although the APLS can be programmed for additional languages upon request, English is the only language that has been requested by patients currently enrolled in the program. Based on the success of the initial rollout, Johns Hopkins expanded the APLS service by adding two additional community pharmacy locations in July 2025. The expansion was supported through technology integration and pharmacy staff training initiatives. For institutions considering implementing accessible labeling services, the APLS used at Johns Hopkins is an externally developed tool successfully integrated into existing pharmacy workflows. Key steps in implementation have involved coordinating with vendors, integrating the system into pharmacy dispensing software, and providing thorough staff training. Institutions should assess the needs of their patient population, explore available technology solutions, and collaborate closely with pharmacy staff and leadership to ensure a smooth and effective rollout.

The APLS service represents an essential advancement in outpatient pharmacy services by improving accessibility and promoting safe, independent medication use for visually impaired patients. APLS provides an effective model for accessible labeling that aligns with patient needs, regulatory standards, and the broader mission of advancing access to care in both the outpatient community and ambulatory care settings.

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1. CDC. Fast Facts: Vision Loss. Vision and Eye Health. Published May 21, 2024. https://www.cdc.gov/vision-health/data-research/vision-loss-facts/index.html.

2. Giles SJ, Panagioti M, Riste L, et al. Visual impairment and medication safety: a protocol for a scoping review. Syst Rev. 2021;10(1):248. Published 2021 Sep 15. doi:10.1186/s13643-021-01800-8.

3. Moore W. State Board of Pharmacy - Accessible Prescription Labels, Bag Tags, and Medical Guides for Blind, Visually Impaired, and Print Disabled Individuals - Regulations.; 2023. https://mgaleg.maryland.gov/2023RS/chapters_noln/Ch_280_hb0456T.pdf.

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Ally Rhea

PharmD Candidate 2027

University of North Carolina Eshelman School of Pharmacy

Chapel Hill, NC

Sai Wright, PharmD, MBA, MSPH

Clinical Pharmacy Programs Manager

Johns Hopkins Care at Home

Baltimore, MD

Laurel Uhomba, PharmD, MBA, MPH

Johns Hopkins Care at Home

Baltimore, MD