If you’ve ever been diagnosed with a health condition, there’s a good chance that your doctor prescribed you some form of therapy or medication as treatment. But what if you weren’t prescribed the same medication as someone with the same condition who lives in another town? This happens for many reasons; for example, different treatments are better for some people than others, and each health plan has its own drug formulary. There are also some situations where lack of access to care, cost, and implicit bias can create health disparities, or inequitable differences in how treatments are prescribed. The term pharmacoequity is an aspect of health equity with the aim of improving access and use of evidence-based medical treatments.
What is pharmacoequity? It is the idea that everyone has access to the “most appropriate, evidence-based medication indicated to improve their health, regardless of race, class, or availability of resources.” The term was coined and defined by Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh School of Medicine and a health disparities researcher.
Dr. Essien and his colleagues have published several medical studies that highlight inequities in how specific cardiovascular treatments are prescribed. They found that among 110,000 individuals within the Veterans Health Administration system who had atrial fibrillation, Black people were up to 26% less likely to receive the latest, most effective blood thinners for stroke prevention — treatments that are now considered standard of care.
Prescribing patterns reflect one domain of this inequity. An undercurrent of healthcare bias — particularly racial bias — has historically impacted who gets the most appropriate, evidence-based medication for their health condition, according to Dr. Essien. “Although implicit bias training now fills medical curricula across the country, systemic solutions are also needed,” he wrote in an article about pharmacoequity. “Data audits of provider prescribing practices through health equity dashboards as well as electronic medical record-based innovations that make the right choice the easy choice for physicians to prescribe therapies are just two system-level strategies to reduce the harms of health care bias.”
There are other barriers to pharmacoequity, such as affordability and access. A 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%). Additionally, people are less likely to take their medicine if it is harder to get. A study of 3.1 million people aged 50 and over found that there was a decline in medicine adherence in the first three months after their pharmacy closed — a difference that continued over 12 months and was greater among those who lived in neighborhoods with fewer pharmacies.
“When it comes to getting members the medications that are optimal for their conditions, several factors can influence equity, including transportation access and cost,” said Colleen Haines, chief clinical officer for Elevance Health’s pharmacy benefit manager, CarelonRx. “At CarelonRx, we’re working to identify and remove these barriers so people can get the medications they need, when they need them.”
The CarelonRx pharmacist-led case management program, which started in January 2021, helps members who do not take their medication as prescribed. A team of pharmacists contacts members by phone, asking a series of questions to gauge whether the individual may be experiencing barriers in accessing care. This is critically important, as 30–50% of adults in the United States do not take their long-term medications as prescribed.
“Our program also addresses access and other health-related social needs. One of our members was using a shipping service to get his medication because he didn’t know home delivery was an option,” Haines said. “It was a problem for him because he never knew when the deliveries were going to show up. Our pharmacist case manager arranged for mail-order pharmacy services and learned from speaking with the member that he was looking for a lower-cost apartment and recreation opportunities that included transportation. She was able to help connect him with resources for all of these.”
This is just one example of how proactive, personalized intervention can make a difference in the health — and the lives — of people who rely on the healthcare system. Pharmacoequity is a piece of the health equity equation, ensuring that everyone has the chance to be as healthy as possible.