Medication Access Framework Identifies Social Determinants of Health


The framework describes the cyclic nature of medication access, beginning with the patient’s awareness of their illness or condition, and ending with adherence.

The Pharmacy Quality Alliance (PQA) has developed a "Medication Access Framework for Quality Measurement" in order to speak to social determinants of health that may affect medication access and contribute to poor health outcomes. The cyclical and holistic framework identifies 7 key areas in which patients encounter challenges when trying to access medications, as well as the structural, financial, and personal barriers patients within each of those areas.1

“Access to medications is an important part of high-quality, value-based healthcare,” said Matthew Pickering, PharmD, senior director of Research and Quality Strategies at PQA, in a prepared statement.1 “Improving access, which affects adherence and patient outcomes, requires a focus on the social determinants of health. The framework we have developed holistically defines medication access and identifies gaps in quality measurement that could address the financial and nonfinancial factors that stand between patients and the medications they need.”

According to Lee Holland, PharmD, MPH, research fellow for PQA, over $300 billion in additional health care cost is generated due to a lack of patient access every year. During PQA's recent webinar Medication Access: Leveraging Quality Measurement to Address Social Determinants of Health, Holland said patient outcome, whether it be on an individual or environmental basis, can ultimately be improved by health care stakeholders’ active effort to account for the social determinants of health.

The framework describes the cyclic nature of medication access, beginning with the patient’s awareness of their illness or condition, and ending with adherence. The key areas of the cycle are: perceived need, help seeking, encounter, prescribing, prescription adjudication, prescription dispensing, and adherence.2

Each of those 7 nodes within the framework describe common barriers that patients may face with medication access. The most common barrier cited was health literacy, followed by insurance and medication-related cost.1-2 Other common barriers include transportation, language, patient attitudes and beliefs; and provider availability.2

PQA’s Access to Care Roundtable, a multi-stakeholder panel of experts in social determinants of health, health care quality improvement and quality performance measurement supported by the National Pharmaceutical Council, was responsible for the recommendations within the framework. Their recommendations included viewing "cost” as the culmination of both indirect and direct costs, the use of telehealth to help overcome transportation barriers, patient and community engagement; and the role of pharmacy.

“[There is] an increased value for different operation models implemented within pharmacies. Pharmacies can engage with health plans to improve vaccinations within community, and potentially screen for certain issues or provide referrals to community programs,” said Pickering, during the webinar. “The role of pharmacy within PQA is top of mind to have value in social determinants of health and in health care.”


  • New Medication Access Framework Identifies Opportunities for Quality Measurement to Address Social Determinants of Health [news release]. Alexandria, Va. Published March 7, 2019. PQA website. Accessed March 14, 2019.
  • Pharmacy Quality Alliance. Access to Care: Development of a Medication Access Framework for Quality Measurement. PQA website. Published March 2019. Accessed March 19, 2019.

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