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ACCESS is Key: Providing Care for Underserved Populations

Updated: Jun 11

By Hannah Vitale, PharmD Candidate 2024 and Kimmy Nguyen, PharmD, BCACP, BC-ADM, TTS


Introduction

In the US, there are over 1,400 operational clinics under the National Association of Free and Charitable Clinics.(1) Volunteers in Medicine (VIM) is one such organization with over 90 clinics across the country. Free clinics offer affordable, quality healthcare to uninsured or underinsured individuals. According to the CDC, 8.4% or 27.6 million Americans of all ages did not have health insurance in 2022.(2) Ambulatory care pharmacists play a vital role in the management of chronic conditions, like hypertension and diabetes among many others. My rotation at Volunteers in Medicine in Wilkes-Barre, PA, inspired me to emphasize how pharmacists can enhance care for underserved populations through ACCESS.


Table 1. Components of ACCESS












Assistance Programs

Providing care for underserved populations requires finding ways to ensure that evidence-based care plans can be enacted. Here are several resources that may help patients afford expensive and potentially life-saving therapies:


Manufacturer Coupons

  • Reduces prescription costs, but generally only usable by patients with commercial insurance

Discount Cards: SingleCare, GoodRx, and WellRx

  • Use the website or app to search medication name, strength, and quantity to compare prices at local pharmacies in the patient’s area

Patient Assistance Programs:

  • Programs offered through drug manufacturers that provide one year’s worth of medications at no cost for eligible patients

  • Check program websites frequently for changes in product offerings

  • PhRMA’s Medicine Assistance Tool (MAT) (Link)


Scan the QR code to access the MAT tool




Table 2: Example Patient Assistance Programs (accurate as of 09/23/2023)

Drug Company

Selected Requirements

Eligible Medications

Astrazeneca

AZ&Me Prescription Savings Program

Link

URL: https://azandmeapp.com/

  • ​Must be a US resident

  • No prescription drug coverage

  • Annual income < 500% FPL for specific products

  • Income < 300% for primary products

  • Medicare: Cannot be eligible or enrolled in Low Income Subsidy (LIS) for Medicare D

Bevespi, Aerosphere, Breztri, Byetta, Calquence, Daliresp, Farxiga, Fasenda, Faslodex, Imfinzi, Imjudo, Iressa, Kombiglyze XR, Lokelma, Lynparza, Onglyza, Pulmicort Flexhaler, Qtern, Saphnelo, Symbicort, Symlin, Tagrisso, and Xigduo XR

Bristol Myers Squibb

Bristol Myers Squibb Patient Assistance Foundation (BMSPAF)

Link

URL: https://www.bmspaf.org/eligibility

  • Must live in the US

  • No prescription drug coverage

  • Medicare: Proof of spending over 3% of household income on out-of-pocket costs for the year assistance is needed

Abraxane, Camzyos,Eliquis, Empliciti, Idhifa, Inrebic, Istodax, Nulojix, Onureg, Opdivo, Opdualag, Orencia, Pomalyst, Reblozyl, Revlimid, Sotyktu, Sprycel, Thalomid, Vidaza, Yervoy, and Zeposia

  • Must live in the US

  • No prescription drug coverage

  • Not enrolled in government programs for prescription coverage (excluding Medicare)

Anoro Ellipta, Arnuity Ellipta, Benlysta, Breo Ellipta, Flovent Diskus, Flovent HFA, Imitrex, Incruse Ellipta, Jemperli, Lamictal, Lamictal ODT, Lamictal XR, Malarone, Mepron, Nucala, Relenza, Serevent Diskus, Trelgy Ellipta, Zejula

  • No prescription drug coverage

  • Provides some vaccines

Belsomra, Delstrigio, Dificid, Emend, Gardasil 9, Isentress, Janumet, Janumet XR, Keytruda, MMR, Noxafil, Noxafil DR, Pifeltro, Pneumovax 23, Prevymis, Primaxin, Recarbrio, Recombivax Hb, Stomectol, Vaqta, Varivax, Vaxeuvance, Verquvo, Welireg, Zepatier, Zerbaxa, Zinplava, Zolinza

  • Must live in the US

  • Limited or no prescription drug coverage

Adakveo, Afinitor, Afinitor Disperz, Beovu, Coartem, Cosentyx, Entresto, Extavia, Gilenya, Ilaris, Jadenu, Jadenu Sprinkle granules, Kesimpta, Kisqali, Leqvio, Luthathera, Mayzent, Mekinist, Piqray, Pluvicto, Promacta, Rydapt, Sandostatin Lar Depot, Scemblix, Tabrecta, Tanfinlar, Tasigna, Tykerb, Vijoice, Votreient, Xiidra, Zarxio, Ziextenzo, Zykadia

  • ​Must be a US resident

By 01/01/2024

  • New income requirement below 300% of FPL

  • Below 100% of FPL for vaccines

Celontin, Depo-estradiol, Duavee, Estring, Norpace Cr, Nurtec, Premarin, Premphase, Prempro, Synarel, Tikosyn, Trecator, Zarontin, and Zavzpret


Specialty Care: BeneFIX, Cibinqo, Elelyso, Eucrisa, Liftfulo, Oxbryta, Somavert, Vyndaqel/Vyndamax, Xeljanz, Xyntha


Vaccines: Abrysvo, Prevnar 13, Prevnar 20, Trumenba


Oncology: Besponsa, Bosulif, Braftovi, Daurismo, Ibrance, Inlyta, Lorbrena, Mektovi, Mylotarg, Talzenna, Vizimpro, Xalkori

Sanofi Patient Assistance Connection

Link

URL: https://www.sanofipatientconnection.com/patient-assistance-connection

  • Must be a US resident

  • No prescription drug coverage or commercial insurance with no access to prescribed medications

  • Annual household income <400% FPL: Must provide Medicaid denial

  • Medicare: Part D and meets FPL requirement

Adacel, Admelog, Apidra, Imovax, Insulin Glargine, Lantus, Lovenox, MenQuadfi, Mozobil, Multaq, Pentacel, Poliovirus and Haemophilus b Conjugate, Prifitin, Soliqua, Tenivac, Thymoglobulin, and Toujeo

  • Must be a US resident

  • No prescription drug coverage

  • Must meet income requirement

Bendeka, cyclosporine capsules/oral solution, Galzin, Granix, and Polycom

FPL: Federal poverty level


Collaboration with Other Providers

Collaboration with other providers is a fundamental pillar of care in free clinics or low-resource clinic settings. In environments where comprehensive resources may be limited, healthcare professionals must work seamlessly as a team. Being acutely aware of the services available within the clinic and knowing when to refer patients to specialists or support services is paramount to ensure holistic care. We've facilitated appointments for dental, counseling, and nutrition services during pharmacy visits, ensuring patient access to a full spectrum of care. This collective effort enhances the impact of care, delivering a more comprehensive and effective healthcare experience.


Connection with Community Resources

As a rotation student, getting used to a new pharmacy setting and understanding available resources for each new location can be daunting. During appointments, many patients described needing help with transportation, food insecurity, and housing needs. While I’m native to Northeast PA, I wouldn’t say I had a thorough understanding of all the community resources to recommend. The first step was to talk with clinic staff and healthcare professionals to get a better understanding of existing resources that are already commonly recommended. For additional support, I’d recommend findhelp (link), a tool that locates local options based on a patient's zip code, covering housing, transportation, healthcare, education, and more.


Expanded Clinical Services

Ambulatory care pharmacists typically handle medication reconciliation, device training, and medication counseling under collaborative drug therapy management protocols. At a free clinic or other low-resource settings, the pharmacist’s role may extend beyond these responsibilities. Identifying service gaps and collaborating with other healthcare professionals for new opportunities enhances comprehensive care access. During my VIM experience, I witnessed pharmacist-run spirometry and supported a vaccines initiative via patient assistance programs, showcasing the extended roles pharmacists can play.


Supply of Resources for Health Literacy and Language Barriers

In various pharmacy settings, addressing health literacy and language barriers is essential. VIM employs an interpreter app for visits, but the significance of written educational materials in diverse languages can't be overstated. While online resources may offer multilingual options, clinic-specific handouts are crucial. For my rotation site, this encompassed providing directions in Spanish for local hospital lab work and details on nearby pharmacies. Maintaining a readily available supply of patient-friendly materials in relevant languages is vital for overcoming communication obstacles and ensuring comprehensive care.


Support Through Student Learners and Trainees

Utilizing pharmacy residents and students to assist with clinic services not only bolsters their experiential training, but also brings fresh perspectives on addressing social determinants of health. This reciprocal relationship enhances the clinic's capacity to provide comprehensive care while enriching the educational experience of these future healthcare professionals, and this ultimately fostering a dynamic environment of learning, innovation, and improved patient outcomes.


Conclusion

As a final-year student pharmacist, my recent 5-week ambulatory care rotation in a free clinic setting provided valuable insights applicable to future rotations and my career. I observed ambulatory care pharmacists addressing language, health literacy, medication access, and resource challenges. In the end, ACCESS is key to providing quality care for underserved populations, and I aim to empower fellow pharmacists by sharing our experiences and resources.

 

1. National Association of Free & Charitable Clinics: NAFC. The National Association of Free & Charitable Clinics. Accessed September 11, 2023. https://nafcclinics.org/.

2. CDC National Center of Health Statistics. U.S. uninsured rate dropped 18% during pandemic. Centers for Disease Control and Prevention. May 16, 2023. Accessed September 11, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/202305.htm#:~:text=8.4%25%20or%2027.6%20million%20Americans,or%2033.2%20million%20in%202019.

 

Hannah Vitale

PharmD Candidate 2024

Wilkes University Nesbitt School of Pharmacy

Wilkes-Barre, PA






 

Kimmy Nguyen, PharmD, BCACP, BC-ADM, TTS

Assistant Professor of Pharmacy Practice

Wilkes University Nesbitt School of Pharmacy


Ambulatory Care Clinical Pharmacy Specialist Volunteers in Medicine

Wilkes-Barre, PA

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