A partnership between specialty pharmacy accelerator Shields Health Solutions and Bronson Healthcare in Michigan improved health outcomes for people with rheumatoid arthritis (RA) facing food insecurity and other challenges related to social determinants of health (SDOH), according to speakers at Asembia’s AXS25 Summit, in Las Vegas.
Limited access to nutritious food led some Bronson patients with RA to rely on more affordable, processed foods, which may have contributed to increased inflammation. Once pharmacists became involved, patients were connected with food pantries and/or received financial assistance to access healthier food options, noted Carolkim Huynh, PharmD, CSP, the director of clinical outcomes at Shields.
Dr. Huynh noted that 80% of clinical outcomes are affected by nonclinical factors such as food insecurity, and that even excellent medication adherence (>93% proportion of days covered) does not always translate to improved health outcomes (Br J Clin Pharmacol 2012;73[5]:691-705).
Such challenges may be part of the reason why some patients with RA struggle—a hypothesis that helped inform the current study. “We realized that about 50% of Bronson patients living with rheumatoid arthritis were doing well, but were not doing their best; they were not in remission,” Dr. Huynh said. “We wanted to understand why they were not meeting clinical goals.”
To better understand these shortfalls, the investigators administered a detailed SDOH screening using a questionnaire developed by the Centers for Medicare & Medicaid Services (bit.ly/4lnDwGK). The screening revealed that food insecurity was a common challenge among individuals with RA, with 10% to 15% of the patient population identified as being in greatest need of support. Pharmacists were well positioned to do something about this, given that they had at least 12 contacts with patients per year, Dr. Huynh noted.
Working alongside social workers, Shields and Bronson pharmacists helped patients identify sources of healthy food. When scheduling constraints made it difficult for patients to meet with a social worker, pharmacists directly referred them to local food pantries. The goal was not only to document the issue, but to take meaningful action.
“Patients told us they had answered these same questions before—sometimes multiple times,” Dr. Huynh said. “But this time, they saw follow-through and support.” This proactive approach led to more frequent pharmacist interactions with some patients—up to five times more than usual.
After one year, 75% of patients with RA who had received food-related support had significantly improved Routine Assessment of Patient Index Data 3 (RAPID3) scores. One example cited at Asembia showed a RAPID3 score dropping from 25.7 to 14.3 after the patient received referrals to food pantries and education on an anti-inflammatory diet.
“Pick one barrier and streamline the resources to address it,” Dr. Huynh advised as a start, because trying to address every SDOH barrier at once could be overwhelming. Roughly 10% to 15% of patients will need this level of support, not everyone, Dr. Huynh noted, adding that Shields plans to continue addressing SDOH with its partners.
What Payors and Manufacturers Can Do
Another Asembia session focused on the financial effects of healthcare disparities on the healthcare system. Speakers cited a 2022 Deloitte analysis showing that healthcare inequities cost the U.S. healthcare system $320 billion annually, a figure that analysts said could reach $1 trillion annually by 2040 if inequities are not reduced.
| Table. How Health Disparities Can Increase Healthcare Spending | ||||
| Disease area | Health disparity | Annual cost of disease (in $U.S. billions) | Spending associated with the disparity, % | Unnecessary spending associated with the disparity (in $U.S. billions) |
|---|---|---|---|---|
| Diabetes | Black adults are 60% more likely than whites to be diagnosed with diabetes and are 2 to 3x more likely to have complications | 327 | 4.8 | 15.6 |
| Asthma | Rate for those living under the FPL is 11% vs. <7% for those who are >2x the FPL | 56 | 4.3 | 2.4 |
| FPL, federal poverty level. Source: Deloitte analysis of data from the Department of Health and Human Services, CDC, and the American Diabetes Association. | ||||
For example, according to the Deloitte analysis, delayed diagnosis of diseases such as diabetes—which is more common among minority groups—increases the risk for complications that require expensive medications or intensive oversight, leading to $15.6 billion in unnecessary healthcare spending annually (Table). Deloitte analysts added the impact of these and other healthcare inequities together to reach the aforementioned $1 trillion figure. Inequities in preventive services and health screening make some people more susceptible to illness than others, while unequal access to medications or treatments may prolong that illness or force healthcare professionals to deploy more expensive therapies.
“One trillion is such a huge number; it’s hard to wrap your mind around,” said Chara Reid, PharmD, the national sales senior director at Cencora. Seeing that number intensified Dr. Reid’s efforts to address healthcare inequities by helping improve distribution of specialty medications to everyone who needs them.
“Healthcare should be delivered as close as possible to where people live, and specialty medications should be available to everyone,” said Dr. Reid, adding that she personally does not live in a big city, which could make access to care difficult if it was not available in her local community.
Medically Integrated Dispensing
Geographic challenges can be reduced through medically integrated dispensing, which enables patients to receive treatment and access specialty medications directly from the provider’s pharmacy care team, noted Christie Smith, PharmD, MBA, Cencora’s vice president for Specialty Payer Strategy. Providing efficient access to specialty medications for patients through medically integrated dispensing lowers overall healthcare costs, Dr. Smith said.
Technology is key to such efforts. In a typical medically integrated dispensing model, providers and pharmacists both have access to the full patient medical record in real time and can adjust medications accordingly. The model lowers costs in several ways, Dr. Smith noted. “Because pharmacists have access to patient medical records, they can coordinate care directly with the provider based on information gathered at the most recent office visit, including scans, blood work, side effects, etc.,” she said. “This allows for dose adjustments before the prescription is filled, rather than sending an old dose of a medication that has to be destroyed.”
One analysis found that medically integrated dispensing yielded $1 million in savings in oral chemotherapy drugs at five outpatient cancer centers, by avoiding fills of outdated prescriptions (J Oncol Pharm Pract 2019; 25[7]:1570-1575). Payors can choose to prioritize coverage of medications offered via medically integrated dispensing, Dr. Smith noted.
“Payors should explore medically integrated dispensing, which could result in lower total cost of care, less waste of high-cost specialty medication and higher patient satisfaction with improved health outcomes,” Dr. Smith added. Any savings, she noted, could go toward lower customer premiums or other programs aimed at reducing health disparities.
The sources reported no relevant financial disclosures beyond their stated employment.
This article is from the August 2025 print issue.