When it comes to prescription medications, pharmacists rarely give customers the choice of "paper or plastic." But under a growing program by Premera Blue Cross of Washington state, brown-bagging it may be the next big trend in health care. Premera sends customers who use five or more prescription medications a brown bag and instructions to fill it with their vitamin and herbal supplements, in addition to their prescription and over-the-counter drugs. Doctors then inspect the bag for potentially dangerous interactions--interactions that, by some estimates, kill up to 200,000 patients each year. In the first year of the program, more than 50,000 clients received bags; 27 percent needed a new dosage or to be taken off a medication entirely.

Patients don't always realize the importance of telling their doctors what vitamins and herbal remedies they take, and doctors don't always have a record of what other doctors prescribe. "You're taking multiple medications from multiple prescribers," explains Dr. Ed Wong, pharmacy director for Premera. "The primary doctor, the endocrinologist, the rheumatologist, the emergency room--they don't always communicate effectively." The program initially targeted clients 55 and older in Washington state, but it's being expanded to include all clients who are at least 19 and to other states.