Evaluation of institutional practices for medication access for uninsured patients

Medication cost is a barrier to adherence for uninsured patients. Current practices at the academic medical center examined here include 1-month coverage of discharge medications through the institution's charitable care fund. This study aimed to characterize the cost, type, and frequency of medications provided via charitable care for uninsured patients at hospital discharge.

Single-center retrospective cohort study.

The study included uninsured patients discharged between July 1, 2022, and June 30, 2023, who received medication(s) paid for by the institution's charitable care fund. Patients were included if they were prescribed medication(s) at discharge from an inpatient service and filled the prescription(s) at an affiliated discharge pharmacy within 72 hours.

A total of 13,272 medications were provided for 2915 unique patients. Patients had a mean (SD) age of 45.21 (19.19) years, 60.48% were male, and a majority (67.89%) self-identified as Black or African American. The total cost of medications provided was $613,315, with a mean (SD) of $46.21 ($231.12) per prescription. Of these, 2221 prescriptions ($182,943) were identified as being eligible for more sustainable coverage options. Within 90 days of discharge, 1392 patients (47.75%) returned to the emergency department or were readmitted, resulting in an estimated health care utilization cost of $9,310,770.

Significant funds were used to provide short-term medication access; however, approximately 16.7% of these medications had alternative coverage options, and nearly half of the patients who received medications re-presented to the hospital within 90 days of discharge. These findings highlight an opportunity to establish a program with clinical pharmacist oversight to ensure continuity of care and sustainable medication access, reduce avoidable health care utilization costs, and improve patient outcomes.