NEWFIELD — Over 10 years ago, in a letter to the editor of the Press Herald, I made a commitment to continue my medication access work via MedHelp Maine until every Mainer knows about and can access a local prescription assistance resource.
Today’s commentary was prompted by a recent high-number birthday and the increased possibility that one day I may be unable to keep this promise. It provides some background on the significant public health issue of unaffordable medicines, a summary of my ongoing work and this renewed pledge to continue to help create centralized programs that facilitate access to unaffordable prescription medicines.
Here are some U.S. mortality statistics for 2017 from the Centers for Disease Control and Prevention, rounded to the nearest 1,000: 42,000 deaths from liver disease; 51,000 from kidney disease; 56,000 from influenza and pneumonia; 70,000 from drug overdose; and 84,000 from diabetes.
Missing, shockingly, are the 125,000 annual deaths estimated by an Annals of Internal Medicine review that are caused by medication nonadherence. “Medication nonadherence” is the term used when patients don’t take medicines as prescribed, often because they either don’t fill their prescriptions at all or because they skip doses or split tablets due to cost.
Just increasing access to health insurance is not the solution. Despite Medicare drug plans, sizable enrollment in Affordable Care Act marketplace insurance and recent Medicaid expansion, unaffordable deductibles and co-pays, as well as bewildering enrollment and other requirements, increasingly contribute to medication nonadherence and poor control of chronic diseases.
About a year or so before my letter, I wrote a successful grant application to support the startup of six hospital-based prescription assistance programs in communities from York to Caribou. Because few medical practices can themselves manage the often time-consuming and burdensome medication access process, physicians can merely refer at-risk patients to such centralized resources. After evaluating a patient’s medication list and financial status, skilled personnel identify the most appropriate sources of help and then manage the application process for both doctor and patient.
The six funded programs helped hundreds of Mainers obtain millions of dollars’ worth of free medications during their startup period. In a single, more recent year, one of them alone obtained nearly $6 million worth of medications for over 400 patients of 135 practitioners, preventing many costly, and perhaps unreimbursed, ER visits and hospitalizations.
These initial programs were pilots for an anticipated statewide network of such resources that would be known and available to every Maine clinician and patient. Because few could be persuaded to routinely report program data, though, neither their physicians nor hospital executives could appreciate their public health and financial benefits and then encourage others to replicate them.
Maine hospitals provide substantial charity care, sometimes even for patients readmitted because they couldn’t afford the medications that they’d been prescribed when the hospital discharged them. Nevertheless, few hospitals outside southern Maine have accepted offers of free program startup or other financial assistance. Indeed, I once returned a grant when additional hospitals declined to accept this money.
For the past decade, I have tried to inform Maine clinicians, hospital executives and public health leaders about how medication nonadherence affects their work and Mainers’ lives. A prescriber survey about unaffordable medicines is being distributed by the state’s professional associations; the results should support my future hospital outreach.
I continue to seek the public health community’s interest and assistance. My networking efforts – which include sharing current peer contact information and updates on new drugs, insurance benefits and options for free and low-cost medications – have admittedly been irregular; I plan to do better. Because hospital auxiliaries and volunteer programs may wish to devote some fundraising to paying for discharge medications, for example, they will be invited to the statewide networking meeting I will convene in September.
I recently requested grant funding to raise public and professional awareness about the extent of medication nonadherence and about how prescription assistance programs are helping Mainers obtain unaffordable medicines. If this proposal is funded, readers should soon learn more about this hidden public health threat, one that causes more deaths than diabetes or drug overdose, that results in at least 10 percent of all hospitalizations and that unnecessarily costs Maine hundreds of millions of dollars each year.
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