Search

Cost-related medication non-adherence (CRN) is a major population health concern in the United States, especially for patients with chronic conditions. It is associated with disease progression and increases the likelihood of emergency department utilization and hospitalization, thereby increasing overall health care expenditures. In this paper, we describe the prescription medication safety net in the United States and assess its reliability. We also introduce Dispensary of Hope (DoH), a charitable medication distribution network, as a reliable medication access program that is capable of filling gaps in medication coverage for low-income and uninsured Americans. Our critical assessment of the medication safety net in the United States suggests that an expansion of DoH could reduce CRN in the United States, improve chronic illness care, and help health systems achieve the triple aim of improving patient experiences and population health while reducing cost.

Objective The purpose of this systematic review was to assess the literature regarding access to, and utilization of medication for type 2 diabetes (T2D) and pre-post improvements in diabetes outcomes for adults enrolled in clinic- or pharmacy-based medication assistance programs. Data sources The databases searched were PubMed, CINAHL, Scopus, Embase, Ovid HealthSTAR, PapersFirst, and OpenGrey. Study Selection Databases were searched from the beginning of each database to Feburary 29, 2020. Articles were included if (1) the population of interest was adults 18 years of age or older with a T2D diagnosis, (2) the study addressed access to medication for diabetes patients in a clinic- or pharmacy-based setting, and (3) the study was conducted in the United States. Data extraction Data extracted from the selected studies included location of study, patient inclusion criteria, sample size, medication assistance program description, and reported diabetes medication access and medication related adherence outcomes. Results Eleven articles met the inclusion criteria for the study. The mean reduction in glycated hemoglobin level following the use of medication assistance programs ranged from 0.45 to 0.8. Across studies, the mean number of antihyperglycemic medications used by patients in medication assistance programs ranged from 1 to 1.9. Medication adherence was reported at 45% across studies that reported adherence measures. Conclusion Among the 11 studies identified that assessed access to medication for adults with T2D using clinic- or pharmacy-based medication assistance programs, study findings indicated that many of these programs showed some positive changes in medication access and diabetes-related outcomes.