No patient should have to decide between filling their prescription or buying food. This principle guides VCH's Medication Affordability Initiative.
Established in 2015, and led by Kimi Manhas, Dr. Lynn Straatman and Dr. Kenneth Gin, the goal of the Medication Affordability Initiative is to create actionable strategies that support patients and care providers address cost-related nonadherence (CRNA).
CRNA is when a patient cannot afford and therefore does not take their prescribed medication. Cost-related nonadherence can include cutting pills, taking lower than prescribed doses, delaying refills and skipping doses. It can also include cutting back on other spending, such as food, bills or rent.
Through collaboration between policymakers, health-care providers, researchers and internal and external stakeholders, the initiative aims to support equitable access to prescription medication using education and engagement strategies.
“We recognized early on that medication affordability is an intricate and multilevel problem," says Kimi Manhas, Clinical Planner at VCH. Kimi spearheaded the project from its conception to its initial funding as a VPSA pilot project.
To tackle CRNA the team had to examine the issue from every level: the patient, the health-care provider and the organization.
At the patient level, they realized that there were people who were not able to afford their prescriptions, who could get sicker and require hospitalization or even die.
“When patients can't afford their medications it leads to increased morbidity and mortality," says Dr. Lynn Straatman, Medical Director, Cardiac Function Clinic, and Interim Medical Coordinator, Vancouver Home Hospice Palliative Care Service at VCH. “This is especially true for patients who are already facing increased healthcare burdens due to other disadvantages in their social determinants of health."
At the provider level, many healthcare providers were unaware of medication affordability issues or solutions; and at the organizational level, many leadership team members were unaware of the impacts of medication affordability, so a systemic approach had not been taken to address the problem.
“We learned that many healthcare providers did not know about the resources available to support patients," says Kimi. “The resources were not easily accessible in one place. If health-care providers have patients who cannot afford their prescription medications, they need a quick and easy way to direct them to the right resources."
Rather than coming up with stop gap solutions, the group has worked to create systemic change so that those most affected by CRNA – women, young adults, Indigenous peoples, those with poorer health statuses and those lacking drug insurance coverage – have more support.
So, what can you do as a physician?
“The first step is to simply ask every patient 'Can you afford your medications?'" says Dr. Straatman. “This simple question lets the patient know that you see them as a whole person. You also need to know what you can do to help: from prescribing medications using the lowest cost possible, to asking about your patient's enrolment in Fair Pharmacare or other programs, to filling out the appropriate special authority forms and determining whether every medication you are prescribing is necessary for their health."
Learn more about the resources and tools created by VPSA's Medication Affordability Initiative. To get involved with the initiative, contact Kimi Manhas (Kimi.Manhas@vch.ca).
