“Do you know what your medications are used for?” “Are you taking your medications routinely?” “Are you able to afford your medications?” “Where is your closest pharmacy?” “Do you have transportation to get there?”
These are all common questions we as pharmacists ask during a routine medication review with a patient or member.
However, the answers to these questions can sometimes be difficult. A patient in rural America may be 50 miles away from their nearest pharmacy. A struggling parent may be faced with the decision to either buy food for their family or pay for their monthly maintenance medication. An immobile senior may not have a reliable transportation method to get to their nearest pharmacy.
By way of looking at patients' and members’ health holistically, pharmacists have the opportunity to contribute to health equity and reduce barriers to care. The concept of “health equity” has been around since the 70s in primary care. In the field of pharmacy, we dig further with the idea of pharmacoequity—the notion coined by Utibe Essien, M.D., that everyone has access to evidence-based medication to improve their health, regardless of race, class, or availability of resources.
The pandemic has given public health, health system leaders, insurers, and policymakers the boldness to innovate around the provision of care. In much the same way, now is the time to reimagine what a just and equitable health system looks like: one in which access to life-saving therapy is universal and not determined by the color of one’s skin, ethnicity, socioeconomic status, or resources. Lives depend on it.
Awareness of barriers to care
The Centers for Disease Control and Prevention (CDC) identifies health disparities as, “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
Access to care is significantly lower in low income and rural communities. Patients lack access to technology and there is sometimes provider lack of cultural or social awareness. Providers may lack awareness in providing longitudinal emotional and educational support to patients such as medication therapy, improving access, education, and paying attention to a patient’s social needs, as well as becoming familiar with resources that are available in the community.
A 2022 Kaiser Family Foundation survey found that those who are taking four or more prescription medicines were more likely to have a hard time affording them (32%) compared to those who were taking three or fewer prescription medicines (20%).
Nearly 30% of those surveyed said that due to costs, they have either cut pills in half, skipped doses, taken an over-the-counter medication instead, or not filled their prescription at all. In 2021, overall pharmaceutical expenditures in the US grew 7.7% compared to 2020, for a total of $576.9 billion.
The continued rising cost of medications and many disease states which rely on branded or specialty medications that are more expensive, means providers and pharmacists need to make sure they consider older generic drugs that are still effective and cost efficient for our members. Sometimes, patients are adamant about a brand name medication because they think a generic version may not be as effective, that’s a myth.
In addition, a JAMA publication highlights that a study of 3.1 million people aged 50 and over found there was a decline in medicine adherence in the first three months after a patient’s pharmacy closed. Medication nonadherence was greater among those who lived in neighborhoods with fewer pharmacies.
Pharmacoequity programs help patients break down barriers and live a healthier life. Actions taken by managed care pharmacists go beyond adherence detection to identify underlying issues, or social determinants of health, which delay a patient receiving appropriate therapy. As pharmacists, we must play an active role in breaking down barriers for our patients and members, contributing to that greater mission of increasing access to medications, driving affordability for all and ultimately, contributing to better health outcomes.
Contributing to pharmacoequity
As a leader and pharmacist at CarelonRx, a division within the Carelon brand, our team speaks with dozens of members throughout the day. There are more than 400 pharmacists and pharmacy technicians who sit in our Clinical Pharmacy Care Center working to reduce barriers to care. Our mission is to improve lives and communities and expect more. As we interact with members, I remind myself and the team of five simple ways we can contribute daily to pharmacoequity:
- Treat members with kindness and mutual respect.
- Listen. It is the most powerful way to build empathy.
- Find solutions to problems, do not contribute to the problem. If cost is a barrier, dig into all options – deprescribing, biosimilars, rebate coupons, etc. If access is a barrier, explore options of home delivery, transportation coverage, etc.
- If I cannot find the solution, connect with community partners near members who can.
- Follow-up. Support a member’s medication adherence by checking in and routinely evaluating barriers to medication adherence. Sometimes, it is simply about showing up.
As a pharmacist and health care professional, I challenge you as my peers to be a part of the solution in contributing to health equity and pharmacoequity. Continue to advocate for patients to help improve access to care and push far beyond what is currently in practice. Together, we can make a difference.
Ami Bhatt is the staff vice president of clinical pharmacy services at CarelonRx, a division within the Carelon brand and Elevance Health’s pharmacy benefit manager.