At the ripe old age of 73, I take six drugs — four prescription and two over-the-counter pills — every day. I keep careful track of them.
But recently, when I received a refill, I noticed my blue pill was now yellow. I was startled, but this was not the first time my pills had morphed into different colors. A few months ago, my white and blue capsule had become white and purple, and before that, my pink tablet turned blue.
When pharmaceutical companies update the shape, size, and colors of medication, it creates the potential for confusion or worse: accidentally taking the wrong pills, or skipping doses, which could lead to serious health consequences.
Every morning, I spread out my pills on the kitchen table and use their color, shape, and size as my guide to ensure I take the right pill at the correct dosage. Other people use pill organizers, which are a great way to keep track of what pill you need to take and when.
When one of my medications arrives with a different color, size, or shape, I wonder if the pharmacy has made a mistake. I don’t take the pills until I’ve had time to check.
This time, the pharmacist explained that the manufacturer had changed distributors for that generic pill, and the new distributor had updated the color. I was lucky I had the means to travel to the pharmacy and that I’m still cognitively aware and can recognize the change. Not everyone is as fortunate.
The Carnegie Mellon University-supported Civic Science data center reports that nearly 70% of Americans take at least one over-the-counter drug regularly, and the average American adult takes two or more prescription drugs daily. Others take nutritional supplements in capsule form.
With so many of us relying on prescriptions and other types of medication, why do drug companies change pill colors, which may confuse even the most attentive consumer?
The main reason is that patent laws actually require generic drug manufacturers to change how pills look to distinguish them from the original brand-name medication. In addition, pharmacies rotate among generic suppliers, all of which may put their own imprint on the shape, color, and size of pills.
That makes it all very confusing for pill-takers.
A 2014 study published in Annals of Internal Medicine found a 34% likelihood of patients discontinuing their medication after the pill changed color. A change in the pill’s shape increased that likelihood to 66%.
More recently, doctors Darrick Lee and Erin M. Noren reported in 2022 that a patient taking a prescription for potassium stopped taking her pills when the pharmacy switched from a neon orange color to white tablets. Another patient’s medication changed appearance nine times in 15 years.
Despite the potential dangers of changing how pills look, each pharmaceutical company has the choice to make a pill of any shape or color, as long as the ingredients adhere to the correct chemical formula. The Food and Drug Administration does not require pharmaceutical companies to coordinate with one another or prohibit them from making changes to their cosmetic formulas.
The reasons pharmacies update their suppliers vary. Sometimes it’s the result of the insurance company telling the pharmacy it has to switch suppliers for a cheaper drug with the same potency and benefits. Insurers are permitted to do this without notifying patients, and new suppliers can create tablets with a different code and color. Once a medication is deemed appropriate to be classified as a generic drug, neither the manufacturer nor the doctor who previously prescribed the medication are obligated to inform the patient of the cosmetic changes.
Federal census data show the U.S. population continues to age, with the share of the 65-and-older population increasing from 12.4% in 2004 to 18% in 2024. As America grays, I wonder who is watching out for older individuals. As we age, our eyesight fails and our cognition may not be as sharp, and people who live alone may not have anyone to scrutinize their medications or help load their pill organizers. It has become the responsibility of the consumer to question the doctor, the insurance company, pharmacist, or manufacturer of the medication about a change.
Compounding the problem, people who receive their drugs by mail may never have meaningful conversations with their pharmacist.
Yet there are some steps patients can take: They can order or request pill packs or blister packs with all your morning, midday, and evening doses packaged separately. Several online pharmacies offer pill pack and blister pack services, including PillPack by Amazon Pharmacy, Accupacrx, CVS Health, and Express Scripts.
Online pill identifier tools, such as those offered by Drugs.com, WebMD, and RxList, identify medications based on color, shape, and imprint. However, these resources shouldn’t take the place of a conversation with a pharmacist or doctor.
Patients also can ask doctors to write “dispense as written” on prescriptions to avoid receiving generic versions, though that may raise prices.
But the onus shouldn’t be on the individual patient. The FDA should issue guidance to drug manufacturers about regularizing the size and shape of generic pills.
My pill’s new yellow color might be pretty. But no one should get a surprise when opening a pill bottle.
Barbara Wolf lives in Birmingham, Ala., where she has spent more than four decades running nonprofit programs to benefit low-income families, and later, directing the Temple Beth-El Foundation.
