Specialty Pharmacists Can Help Identify, Alleviate 5 SDOH Categories

Despite extensive investment and groundbreaking scientific advancements in health care over many decades, medical care accounts for only 10% to 20% of patients’ overall health.¹ What can be far more significant to patients’ health and well-being are other forces and factors in their lives that determine the types of illnesses they experience, how long they live, and how well their bodies function throughout their lifetimes. These social determinants of health (SDOH) include a wide range of factors, from economic stability, education level, family support, housing, and food security to broader societal and environmental concerns such as neighborhood safety, air quality, and water quality.²

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Specialty pharmacists can make a significant impact by identifying and alleviating the additional burdens of 5 SDOH categories, according to Mackenzie Clark, PharmD, APh, BCPS, BCGP. Clark is a pharmacy supervisor at the University of California, San Francisco (UCSF) Specialty Pharmacy and an assistant clinical professor in the UCSF Department of Clinical Pharmacy. The 5 SDOH categories are economic stability, education, neighborhood and physical environment, food security, and community, safety, and social context.²

Starting the Conversation

Conversations between health-system specialty pharmacists and patients can often begin with a simple question posed to a patient, such as, “Do you have a place to store your medication?” The patient’s response can provide evidence of other factors that may be affecting their life apart from their illness. These factors could have a significant adverse impact on their health outcome if not addressed, according to Clark.²

“Many of our specialty medications are refrigerated, so we always have to ask our patients whether they have a place to store them. If they say they don’t have a refrigerator, that will usually prompt a longer discussion about their living conditions, their diet, the security of their housing, and other quality-of-life issues,” Clark said during a panel discussion at the Acentrus 2023 Specialty Conference in San Diego, California. “Once we have more information about the patient and any issues they may be facing, we can make sure they are connected to a resource that can help them.”²

Pharmacists such as Clark who practice in health-system specialty pharmacies (HSSPs) are uniquely positioned to identify and care for patients who receive a diagnosis of a chronic, complex disease or condition and may be adversely affected by SDOH. In addition, health-system specialty pharmacists can play a major role in addressing the barriers to care that these patients often face by referring them to support programs, social services, and other resources.²

The Unique Relationship Between Specialty Pharmacists and Patients

Working collaboratively with providers, specialty pharmacists within a health system or hospital are entrusted to manage high-risk, complex medication therapies for patients. These pharmacists function as embedded members of the clinical care team, where they have regular, direct interaction with both patients and providers as well as access to patients’ medical records via the electronic health record (EHR) system.²

“The integration of HSSP into the clinical care team enables pharmacists to develop deeper relationships with their patients, giving them vital insight into the personal and external circumstances affecting their patients’ overall health and well-being,” Julia Hancock, vice president and general manager of Acentrus Specialty, said during the panel discussion. “Specialty pharmacists outside a health system who do not have direct patient and provider interaction or access to the EHR are unable to provide this same level of clinical management. They are also unable to address patients’ broader needs.”²

Kama Thomas, PharmD, BCACP, the health outcomes and research coordinator for Froedtert Health Specialty Pharmacy in Milwaukee, Wisconsin, explained that the relationship that specialty pharmacists can build with patients is different from the one they may have with their providers. “Because we talk to our patients every month, we build a relationship with them where they’re comfortable opening up to us about what’s going on in their lives. For example, we might learn that they’re struggling with housing concerns, food insecurity, or some other significant issue. That gives us a unique perspective on the patient’s life as a whole,” Thomas said during the discussion.²

Specialty pharmacists may even have more contact with patients than their providers do, according to Clark. Physicians and nurses in the clinic often have a limited amount of time with each patient.²

“As specialty pharmacists, one of the most important things we are able to give our patients is time. We’re very accessible to them, which creates a bond unlike the one they have with their provider. Sometimes they just need someone to listen. We have the time to give them that one-on-one care,” Clark said.²

The Role of HSSPs in Combating Health Inequities

For patients experiencing economic hardship, paying for specialty medications can be a significant barrier to care, especially at a time when they are already struggling with the emotional and physical impact of their diagnosis. In their regular interaction with patients, specialty pharmacists can learn about financial challenges that patients may be facing and connect them to their health system’s internal financial assistance programs and external funding sources, such as state and foundation grants.²

For example, Froedtert Health provided more than $80 million in financial aid to patients in the 2022 fiscal year through its patient assistance program, including for patients referred by the health system’s specialty pharmacists, according to Heather Dalton, PharmD, MS, specialty pharmacy manager at Froedtert Health. “Our goal at Froedtert Health, from a specialty pharmacy perspective, is to support our patients by helping remove financial and other barriers they may face and provide them with the resources they need to live a healthy life,” Dalton said.²

Froedtert Health and UCSF Health, like many HSSPs, provide patients with patient assistance teams to help them apply for insurance coverage, receive timely prior authorizations, and obtain discounts from drug manufacturers that reduce co-pays. Both health systems also offer free delivery of specialty medications to patients’ homes, according to the panelists.²

Additionally, because patients’ health outcomes depend in part on their health literacy, the panelists explained that their HSSPs emphasize the need to provide patients with easily understandable, culturally competent written materials in the languages the patients speak. “We should always assume that patients do not understand until they prove to us that they do,” Clark said. “It doesn’t matter how educated you are; when you’re sick or scared or have some other issue that you’re dealing with, you’re not always able to think clearly.”²

The safety of the neighborhoods where patients live also has a significant impact on their health outcomes. “If I live in a neighborhood where I’m worried about my exposure to gun violence, taking my diabetes medication might not be at the top of my mind,” Thomas said. “When you start talking to patients, you realize there’s often a bigger issue behind nonadherence than just not taking the medication.”²

According to the panelists, pharmacists at their HSSPs are told to refer patients who are unhoused or want to move to a safer neighborhood to their health systems’ social workers. These workers are also embedded in the clinical care team and can help patients find housing and rental assistance.²

Both institutions are also active participants in outreach efforts to alleviate SDOH in their communities. In San Francisco, the UCSF Health specialty pharmacists connect patients experiencing food insecurity with the university’s Division of General Internal Medicine Food Pharmacy, which provides fresh, nutritious meals to community members. The UCSF Health pharmacists are also participants in the UCSF DeLIVER Care program, which includes a mobile unit that provides screening and treatment for communities at high risk for hepatitis C virus (HCV). The specialty pharmacists fill prescriptions and coordinate the delivery of medications for patients who attain a positive test result for HCV.²

Additionally, as payers increasingly move toward value-based reimbursement models, more focus is being placed on SDOH and how they affect health outcomes, according to Neesha Thakkar, PharmD, BCPS, regional account director at Acentrus Specialty. “Although achieving health equity is primarily a societal undertaking, HSSPs have an important role to play in advancing health equity within their own health systems and the communities they serve,” Thakkar said.²

References

1. Hood CM, Gennuso KP, Swain GR, Catlin BB. County health rankings: relationships between determinant factors and health outcomes. Am J Prev Med. 2016;50(2):129-135. doi:10.1016/j.amepre.2015.08.024

2. Clark M, Hancock J, Thomas K, Dalton H, Thakkar N. Combating health inequities: addressing social determinants of health. Presented at: Acentrus 2023 Specialty Conference; April 3-5, 2023; San Diego, CA.

About the Author

Gary Hopkins is a principal with Blanco + Hopkins & Associates, LLC, a health care public affairs firm based in La Cañada Flintridge, California.