Pharmacist strategies for addressing medication cost barriers to equitable health in primary care

Abstract

Cost can be a barrier to achieving health equity for guideline-directed medical therapy; however, ambulatory care pharmacists who provide services in primary care settings can assist in reducing these barriers. Strategies to reduce drug cost should be tailored to patient-specific factors including insurance type, drugs being prescribed, and availability of local and national assistance programs. Pharmacists can use a team-based approach, when possible, to promote health equity in drug access due to cost. The authors provide recommendations that can be incorporated into clinical practice and improve health equity.ambulatory care, drug cost, health equity, pharmacy, prescription, social determinants of health | INTRODUCTIONDrug cost is a barrier to patients obtaining guideline-directed medical therapy (GDMT). 1 Several clinical practice guidelines recommend drug classes that only include agents available as brand name products.These products have significant retail costs, which many patients are unable to afford with or without prescription insurance. Most prescription insurance companies cover brand name drugs at higher tiers, and therefore, require a higher copay and out-of-pocket expense to the patient. While the Affordable Care Act (ACA) has improved insurance access, drug cost can still leave many GDMTs unobtainable due to high deductibles and/or copays. 2 A 2021 West Health-Gallup poll revealed that 18 million Americans cannot afford their drugs, in particular, patients with three or more chronic conditions, eight or more drugs, and households earning less than $24 000/year. 3 This means patients with chronic conditions who cannot afford brand name GDMTs may opt to be treated with older, inferior drug therapies. 2

Pharmacoequity and the clinical pharmacist: Why not us, why not now!

“…Although clinical pharmacists may not be able to impact the actual cost of medications, we can help patients navigate cost strategies as highlighted by Westerhof and colleagues in this themed issue of JACCP. 12 Additionally, clinical pharmacists play a role in working with patients on preventive strategies such as vaccination needs and smoking cessation to help prevent conditions or minimize disease burden. In this themed issue of JACCP we highlight the work of our colleagues in working to achieve pharmacoequity.…”