Elizabeth Gallagher, PharmD Candidate 2023, Lipscomb University College of Pharmacy, February 16, 2023
A new study has been published by RTI International in partnership with Dispensary of Hope to address the question of whether improving medication access for the underserved improves health outcomes while driving down healthcare costs. This study demonstrates how Dispensary of Hope plays a crucial role in providing solutions to patients with barriers to prescription medication access. If you are looking for solutions to promote access to prescription medications to your patients to improve health outcomes and cut costs within the healthcare system, check out the publication on Journal of Managed Care + Specialty Pharmacy (JMCP) here!
According to the most recently updated census data, 27.2 million Americans reported not having health insurance coverage at any point throughout 2021.¹ The uninsured US adult is more likely to skip or delay care due to cost, have higher morbidity and mortality rates, and have inadequate access to quality care.² Additionally, cost of medication presents a major barrier for this patient population with patients consistently reporting out-of-pocket cost as a top reason for medication nonadherence.³ Dispensary of Hope is a charitable medication distributor that utilizes innovative stewardship of the pharmaceutical supply chain to provide prescription medications to qualifying patients free of charge. Millions of dollars of pharmaceuticals are collected and donated annually to pharmacies and safety net clinics to dispense free of charge to uninsured patients with low-income and chronic health conditions. Dispensary of Hope’s mission is to improve medication access to the country’s most vulnerable patient populations.
Do participating health systems see an improvement in healthcare driven outcomes when they provide access to affordable medication for eligible patients? A 2015 analysis of Dispensary of Hope completed by the Advisory Board Company demonstrated decreased health system utilization and cost avoidance of over $2.08M per 1,000 lives annually.⁴ To further address this question, Dispensary of Hope partnered with RTI International in 2021 to conduct an independent, comprehensive follow-up and evaluation of the program.
Does Dispensary of Hope improve patient health outcomes while reducing cost?
The RTI study analyzed data collected from two partnering health systems across a variety of geographical regions in the United States. Health System One (HS1) utilized data covered from the period of July 2016 through December 2019, while Health System Two (HS2) data covered the period of March 2014 through December 2019. A comparator group of patients who did not receive Dispensary of Hope services was selected through inclusion criteria such as age, sex, race and ethnicity, geographical location, and comorbidities. Data collected for each system included emergency department (ED) visits, inpatient encounters, cost per encounter, and the prescription fill history for Dispensary of Hope patients. Subgroup analyses were performed on high utilizers (patients with two or more ED visits or inpatient stays in the pre-enrollment period) and consistent users (patients with at least 12 Dispensary of Hope fills in the 18-month post-enrollment period). The subgroup analyses were completed to further assess the degree of impact the Dispensary of Hope program had for patients in higher need of medication use and their corresponding benefit of access.
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Health System One spanned 13 locations in Tennessee, Kansas, Wisconsin and Indiana with an average number of comorbidities per patient being 3. Health System Two program participants held a comorbidity index of 0.9. Health System One was found to have patients with a higher degree of chronic illness which received a statistically significant benefit from the Dispensary of Hope program and resulted in $3.16 million in savings per 1,000 patients annually.
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Utilization costs for participating patients declined by 27%.
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$3,161 annual savings captured per patient.
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Number of inpatient stays decreased by 20% or 200 per 1,000 program participants annually.
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Health System Two provided one location in the state of North Carolina. With a much lower comorbidity index for this patient population, no statistically significant changes were noted, although patient data trended favorably. Of note, this program location served a diverse patient population with more than half (55.2%) of patients receiving Dispensary of Hope medications identifying as Black/African American.
When considering the original question of whether or not Dispensary of Hope reduces healthcare utilization by improving access to affordable medications, the RTI study answers with a resounding yes. The RTI study effectively demonstrates the substantial impact the Dispensary of Hope program has on reducing costs and inpatient stays for HS1 participants. Although HS2 participants did not see a statistically significant change, data trended favorably while promoting health equity in a diverse patient population. This study demonstrates the need for medication access for the most vulnerable across the United States. It shows the overwhelmingly positive difference that programs like Dispensary of Hope can have on patient healthcare outcomes while simultaneously reducing the financial burden to the healthcare system. As we look towards the future of increasing prescription medication access to the most vulnerable communities in the United States, Dispensary of Hope continues to utilize innovative solutions and impactful relationships to create a long-lasting and meaningful difference in patient’s lives.
To learn more, visit our website www.dispensaryofhope.org or contact Dr. Hillary Blackburn (hillary.blackburn@dispensaryofhope.org) for questions on the study or Anita Stanford (anita.standford@dispensaryofhope.org) for questions about how to participate with Dispensary of Hope as a pharmacy or clinic.
References:
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United States Department of Commerce, United States Census Bureau. Health Insurance Coverage in the United States: 2021. September 2022. Accessed February 10, 2023. https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-278
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Tolbert J, Drake P, Damico A. Key facts about the uninsured population. Kaiser Family Foundation. Published December 19, 2022. Accessed February 15, 2023. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
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Chisholm-Burns MA, Spivey CA. The 'cost' of medication nonadherence: consequences we cannot afford to accept. J Am Pharm Assoc (2003). 2012;52(6):823-826. http://dx.doi.org/10.1331/JAPhA.2012.11088
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Allaire B, Tang Y, Neuwahl S, et al. Does access to free medication reduce health system costs? An evaluation of the Dispensary of Hope program. J Manag Care Spec Pharm. 2023;29(2):187-196. doi:10.18553/jmcp.2023.29.2.187