The Challenges of Patient Access to Medications and Pharmacy Services

FEBRUARY 23, 2018
American pharmacists put in a lot of efforts to provide accessible and affordable high-quality health care. Pharmacists even developed their own principles for health care reform, concerning patient access to necessary medications and pharmacy services.1

The first pharmacist health care reform principle concerns all Americans having access to competent pharmacists. The second principle refers to the prescription plan coverage allowing patients to choose the provider of prescription medications, medication therapy management, and other patient care services provided by pharmacists. The third principle is about providing appropriate funding to pharmacies and pharmacists with regard to the costs spent on buying medications and paying for administration services. Finally, the fourth principle is based on ensuring that pharmacists are able to access the best and most cost-effective medications.1

The American healthcare system, as well as a wide range of health care systems all over the world, creates barriers to patients’ adherence to their medication regimen “by limiting access to health care, using a restricted formulary, switching to a different formulary, and having prohibitively high costs for drugs, copayments, or both.”2 Pharmacists presently become more and more involved in patient-care delivery3 and put a lot of efforts to improve the patients’ access to needed medications and services. A number of current researches show that extremely high costs for medicines and pharmacist services appear to be one of the most important barriers to adherence to medications that are completely out of patients’ control.2

Under such circumstances, the issue of undue high prices for innovative specialty drugs is of pharmacists’ primary inquiry. According to United Health Center for Health Reform & Modernization, it is estimated that annual costs for certain specialty drugs may reach $ 30,000 or even exceed $ 100,000 in some cases.4 These particular drugs already comprise more than a quarter of the U.S. total drug spending and this rate is expected to grow in the near future. Patients adhering to specialty drugs, as a rule, have a complex condition and, in such cases, prohibitively high costs and poor access pose great challenges. It is estimated that annual spending on specialty drugs in the United States may reach over $ 400 billion by 2020, in comparison to $87 billion in 2012.

This challenge does not only concern integrated clinic management, as it appears to be too large burden on a large number of American population, especially considering that there is a growing number of uninsured and under insured U.S. citizens.4 There is also a striking discrepancy between extremely high prices for specialty drugs and the fact that they often are not safe to patients. Lack of experimentation of specialty drugs is often explained for this reason, as is difficulty in finding a correspondent population be tested on.

A workable potential financial model for a solution to the problem of improving patient access to needed medications and pharmacy services would focus on providing more U.S. citizens with full or partial health insurance, without putting a lot of pressure on hospitals and healthcare providers. To balance the interest of patients and healthcare providers for the prices on medicines and pharmacist services, three methods of reducing the direct cost burden on patients have been proposed through recent research.5 

The first method is an “amortization of an expensive drug's costs over time."5 In this case, patients would be allowed to spread the costs for needed medicines and pharmacist services over some period of time that would allow them to accrue the benefits from the reduced downstream costs.

The second method represents a carve-out reinsurance model that is primarily applied to high-cost medical regimens. With the help of this method the challenge from high-priced drugs would be dealt with the help of traditional insurance benefits. Individual techniques for medication management would be allowed before a patient is in need for catastrophic care management.

The third method involves benefiting from declining copayment over some period of time with better patients’ adherence to therapy. The third model deals primarily with handling expenditures for high-cost drugs after the completion of a course treatment. 

Thus, the problem of patient access to needed medications and pharmacy services has been always relevant in the U.S. health care system, but exceedingly becomes even more urgent. Both patients and the health care system in the Unites States would benefit from applying all the three methods of spreading the burden of high costs for medicines and pharmacy services.
  1. American Pharmacists Association. Pharmacy Principles for Health Care Reform. Accessed February 5, 2018.
  2. Osterberg, L., Blaschke, T. Adherence to medication. New England Journal of Medicine353(5), 487-497.
  3. Isasi, F., & Krofah, E. (2015). The expanding role of pharmacists in a transformed health care system. Washington, DC: National Governors Association Center for Best Practices.
  4. United Health Center for Health Reform & Modernization. The growth of specialty pharmacy: current trends and future opportunities. Published April 2014. Accessed February 23, 2018.
  5. Kleinke JD, McGee N. Breaking the Bank: Three Financing Models for Addressing the Drug Innovation Cost Crisis. American Health & Drug Benefits8(3), 118. Published May 2015. Accessed February 23, 2018.

Dr. Jasmine Facchetti, PharmD, B.A
Dr. Jasmine Facchetti, PharmD, B.A
Dr. Jasmine Facchetti is an Italian/Persian pharmacist born and raised in Marbella, Spain and currently living in Los Angeles. She studied Doctor of Pharmacy at Chapman University school of pharmacy after obtaining her B.A in Psychology from California State university. She fluently speaks Spanish, Italian, Persian, English with a goal of helping people live longer, better, healthier lives.
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