Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress

Abstract

The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the U.S. experience the highest costs of care and unequal access to high quality, evidence-based medication therapy. “Pharmacoequity” refers to equity in access to pharmacotherapies, or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein we describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, we describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path towards achieving pharmacoequity.

Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US

“…Consistent with our findings, SDOH factors, such as health insurance and access to care, have been previously identified as being associated with appropriate statin use . Potential mechanisms or manifestations of systemic racism that could impact racial disparities in primary prevention statin use could arise from patient factors, such as trust in health care and pharmaceutical companies; health system factors, such as clinician bias and differential quality of care; structural factors, such as neighborhood deprivation and pharmacy access; and insurance factors, such as limited coverage and unaffordable drug costs . Together, these findings suggest that existing inequities in access to preventive care may be associated with the underuse of statins across races and ethnicity groups.…”

Single-Pill Combination Product Availability of the Antihypertensive Regimens Used for Intensive Systolic Blood Pressure Treatment in the Systolic Blood Pressure Intervention Trial

“…15 Assuming that 12.3% of the 20.7 million are eligible for the SPRINT trial, 26 then over 2.5 million SPRINT-eligible US adults do not have access to a class-equivalent SPC product. An important consideration for antihypertensive pharmacoequity 27,28 (ie, the equitable provision of medication for all) is that, should new SPC products be developed and marketed to US patients, these products would likely be brand-name only and be associated with higher cost burdens to the patient (especially disadvantaged persons) and the health system, limiting their utility until they become generic. Although new SPC options may be beneficial, the utilization of currently available SPCs could also be substantially improved.…”

The urgent need for nurse practitioners to slow antibiotic resistance and advance health equity through appropriate antibiotic prescribing

“…The first, Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress (2022), examines how access to prescription drugs in the United States is shaped by deeply entrenched inequities. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race, ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions (Chalasani et al, 2022). Research indicates that individuals from racial and ethnic minority groups are less likely to be prescribed both novel treatments and commonly used generic therapies and less likely to receive guideline-directed or emergency-use treatments and preventive or acute care therapies (Chalasani et al, 2022).…”