Pharmacist-driven SMART formulary improves pharmacoequity

A large academic medical center piloted a pharmacist-driven charitable medication access program. The financial and health outcomes of the program were evaluated and compared with existing benchmarks.

This retrospective cohort study analyzed electronic health records for study participants and pharmacy dispensing information. The study period was January 1, 2023, through August 31, 2024.

A pre-post analysis was performed to determine the impacts of the program. First, characterizations of the number, type, and cost of medications provided to charitable care patients via the Streamlined Medication Access for High-Risk Patients (SMART) formulary were compared with existing benchmarks. Second, emergency department (ED) and hospital utilization data were reviewed for charitable care patients after implementation of the SMART formulary and compared with utilization prior to implementation.

From January 1, 2023, through August 31, 2024, the SMART formulary provided 6791 medications to 418 unique patients, totaling more than 4.5 times more prescriptions to nearly 3 times more unique patients than the benchmark charitable care spending (March 1, 2019, to June 30, 2021). Drug costs per patient and costs per prescription were reduced by 62% and 72%, respectively. Reductions in ED visits (10%) and hospitalizations (34%) occurred, reducing the total health care spend by $6163 per month. The SMART formulary team facilitated the completion of 74 patient assistance program applications and connected patients to manufacturer insulin savings programs, estimating an additional indirect cost savings of $310,168.

The SMART formulary reduced the total cost of care for a cohort of charitable care patients enrolled in a primary care clinic at a large urban academic medical center in Baltimore, Maryland.