Asembia 2021: How Can Pharmacy Bridge the Healthcare Equity Gaps?

Equity is a buzzword in healthcare these days. A panel discussion at the Asembia’s 2021 Specialty Pharmacy Summit discussed how to translate good intentions about bridging gaps into concrete action. Health literacy, pharmacy deserts, and income disparities were just a few of the subjects discussed.

The three-member panel on Wednesday included Mike Valenta, MBA, associate vice president, policy and government relations at Merck; John Wigneswaran, M.D., chief medical officer at Walmart, and Lilian Ndehi, Pharm.D., MBA, BCPS, associate vice president, pharmacy clinical and specialty strategies at Humana. George Van Antwerp, a managing director at Deloitte who focuses on pharmacy and PBM client, was the moderator.

Van Antwerp kicked off the discussion by relaying an interview he recently had with a patient who had to take three busses in one day in order to access her medications. “Those types of complications really make it difficult for somebody to be adherent and actually get better in their condition,” he said.

Panelists discussed opportunities where pharmacies could step up and help address care gaps. Touching on efforts Walmart made in partnership with the Cleveland Clinic and American Diabetes Association, Wigneswaran described how the company aims to tackle diabetes disparities by targeting at-risk patients and providing them with continuous glucose monitors (CGM).

A patient with diabetes that makes under $30,000 a year has a two to three times increased risk of mortality or poor outcomes, he explained. “If you look at Medicare patient population, you see far fewer African Americans and Latinos even being offered a CGM device,” Wigneswaran said.

Understanding the specific needs of patient populations helps improve outcomes and paves the way for individualized care, the experts stressed.

“We always have to think about customizing it, really delivering that patient-centered whole person health,” said Ndehi. Capturing data from pharmacies on factors like medicine non-adherence can help payers, like Humana, target individuals and intervene on their behalf. However, these interventions cannot be one-off efforts, she said. Longitudinal follow-up is necessary.

Wigneswaran also described Walmart’s efforts to take HIV in Georgia and reduce disparities through similar means. “We're also doing behavioral and social interviewing skills with our pharmacists so they can have those discussions with specific groups of people, particularly LGBTQ+ individuals,” he said.

Diversifying clinical trial populations and clarifying which interventions work best for which patients will not only cut down on waste but also help improve intervention efficacy, the panel agreed

However, the complexity of the healthcare system creates challenges for populations that may not have access to the internet or time to spend hours on the phone trying to get help understanding their health plan.

“Many of us in the system struggle sometimes to figure out how to navigate [the system]. How does someone that doesn’t have that advantage, or even somebody that maybe doesn’t have the time to do that?” Van Antwerp asked.

Valenta talked about the importance of a unified effort. “I think that that's one of the things that we need to do a better job of as an industry — to really come together and figure those things out because if we don't, we're going to continue down this path of being independent.”