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Pharmacist-driven SMART formulary improves pharmacoequity.

Erin Van Meter, Caitlin Dowd-Green1, Shay Roth

  • 1Johns Hopkins Health System, 600 N Wolfe St, Carnegie 180, Baltimore, MD 21287.

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A pharmacist-led charitable medication program significantly increased access to medications for low-income patients. This initiative reduced drug costs by over 70% and decreased hospitalizations by 34%.

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Area of Science:

  • Health outcomes research
  • Health services research
  • Pharmacy practice

Background:

  • Charitable care patients often face significant barriers to medication access.
  • Existing benchmarks for charitable medication spending and utilization were limited.
  • Academic medical centers can play a role in improving medication access for vulnerable populations.

Purpose of the Study:

  • To evaluate the financial and health outcomes of a pharmacist-driven charitable medication access program.
  • To compare the program's performance against existing benchmarks for medication access and utilization.
  • To assess the impact of the Streamlined Medication Access for High-Risk Patients (SMART) formulary on healthcare costs and patient outcomes.

Main Methods:

  • Retrospective cohort study analyzing electronic health records and pharmacy dispensing data from January 1, 2023, to August 31, 2024.
  • Pre-post analysis comparing medication provision, drug costs, and healthcare utilization (ED visits, hospitalizations) before and after SMART formulary implementation.
  • Benchmarking against previous charitable care spending and utilization data.

Main Results:

  • The SMART formulary provided 6791 medications to 418 patients, exceeding benchmark volume by over 4.5 times.
  • Drug costs per patient and per prescription decreased by 62% and 72%, respectively.
  • Emergency department visits fell by 10%, hospitalizations by 34%, reducing monthly healthcare spend by $6163. Patient assistance programs and savings programs generated an estimated $310,168 in indirect savings.

Conclusions:

  • The SMART formulary effectively reduced the total cost of care for charitable care patients.
  • Pharmacist-driven programs can significantly improve medication access and reduce healthcare expenditures.
  • The program demonstrated a positive impact on both financial and health outcomes for a vulnerable patient cohort.