Pharmacoequity: A New Opportunity for Managed Care Pharmacy

Have you ever thought about why sweatpants have made a comeback in recent years?  

As the world became more homebound during the pandemic, we traded in our dressy ensembles for something more comfortable. No matter our diet, fluctuating weight, or changing stress levels, we took comfort in knowing these pants would fit our everyday needs.  

Patient access to safe, affordable, and effective medications should be as easy as putting on sweatpants. This is where pharmacoequity comes in.   

Coined by Dr. Utibe Essien, pharmacoequity is defined as “ensuring all individuals, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest-quality medications required to manage their health needs.”  

Last year, AMCP thought leaders met to discuss potential sources of racial health disparities as well as barriers to medication use. Consequences of racial and ethnic disparities in medication access include:

1. Failure to achieve clinical outcome goals.
2. Increased rates of hospitalization.
3. Decreased survival rates.
4. Increased total cost of care.  

As managed care pharmacists, we are charged with ensuring our patients have medications that are cost-effective, clinically appropriate, and delivered through the most appropriate channel. For this article, I’d like to highlight three areas of opportunity for managed care pharmacy in its pursuit of addressing racial health disparities: 

1. Affordability of Medications
2. Accessibility of Medications
3. Utilization of Medications 

Affordability of Medications 

The CDC reports 6 in 10 U.S. adults have a chronic illness. And the most common chronic diseases (heart disease, cancer, chronic lung disease, stroke, Alzheimer’s disease, diabetes, and chronic kidney disease) account for 90% of the nation’s $3.8 trillion annual health care costs. These chronic illnesses also disproportionately affect people of color.  

In addition to a higher prevalence of chronic disease, racial and ethnic minorities have higher financial constraints. For example, this previous Journal of Managed Care Pharmacy (JMCP) article highlighted the most common high-cost medication claims were for disease states that disproportionately impacted Black patients.   

In recent years, patients — particularly people of color — have taken on more cost-sharing as we attempt to manage health system costs. Ideas from AMCP thought leaders regarding equitable benefit design include: 

• Variable cost-sharing, such as sliding scale premiums based on income.
• Preventive medication benefit with low copays.
• Adjusted cost-sharing based on at-risk populations. 

Accessibility of Medications 

We make formulary and coverage decisions with the support of evidence-based research. But what happens when the evidence in evidence-based medicine is racially biased?  

Clinical trials provide the basis for standards of care, so its important clinical trial participants mirror a medication’s targeted population. Unfortunately, a recent report by the FDA shows diversity in clinical trials is still an issue. Although 60% of clinical trial participants were women, only 8% were Black, 6% were Asian, and 11% were Hispanic.  

Clinical algorithms can also add to disparities in care. A recent NEJM article examined the use of race in diagnostic algorithms and how it altered clinical decision-making. It found race-based clinical algorithms negatively impacted at least six different therapeutic areas: cardiology, nephrology, obstetrics, oncology, endocrinology, and pulmonology.  

Bias in evidence-based medicine directs therapeutic resources — including medications — away from racial and ethnic communities of color. Managed care organizations have an opportunity to address this issue through value-based programs and reimbursement. For example, value-based purchasing agreements with drug manufacturers can help prioritize diversity in clinical trials.   

Utilization of Medications  

Managed care organizations use quality metrics and initiatives to ensure our patients are receiving the highest quality of care. But if we want to move towards value-based care, we need to clearly define value and have a way to measure it.  

As we focus on outcomes measures for value-based care, pharmacoequity should be included as a quality measurement. Medication access can be hard to measure, and medication adherence is often used as an indirect measure.  

While it’s true medication adherence is important to achieve therapeutic outcomes, it sometimes doesn’t paint the full story of a patient’s situation. In fact, studies have shown racial differences in adherence persist even in instances of minimal cost-sharing plans. Pharmacoequity measures would help payers go beyond adherence and identify issues that delay a patient receiving adequate therapy.  

The Bottom Line 

The work we do as managed care pharmacists is so vital. We make sure the right patient has the right drug at the right cost. Equitable access to medications would help patients meet their health goals regardless of where they live, how much they make or the color of their skin. 

As we work towards better health outcomes for our patients, pharmacoequity measures provides AMCP with a tangible solution to addressing racial health disparities.