Mitigating racial health disparities is critical to advancing equitable access to health care, including medications and other therapies. At a partnership forum hosted by the Academy of Managed Care Pharmacy (AMCP) earlier this year, the National Pharmaceutical Council (NPC) joined health economists, patient advocates, academicians, and other stakeholders to explore how structural racism and social determinants of health (SDOH) influence health care, including formulary and benefit design.
Participants discussed sources of racial health disparities, their impact on health benefit design, and strategies to improve equity in health care, specifically managed care pharmacy. The proceedings from the forum are now available in the Journal of Managed Care and Specialty Pharmacy.
NPC sponsored the forum, “Racial Health Disparities: A Closer Look at Benefit Design,” and presented relevant work, including its commentary Ignoring Inequitable Benefit Design Is Not an Option, which encourages employers to expand diversity, equity and inclusion (DEI) practices to ensure that all low-wage workers have affordable access to health care, as well as NPC's Myth of Average booklet on the importance of considering individual treatment effects to provide optimal care.
Forum participants made recommendations to reduce structural and organizational issues in formulary and benefit design that may impact racial health disparities in the use of medications and related therapies, including:
- Improving existing gaps in data through efforts to increase diversity in clinical trials and real-world evidence, and design trials to better detect possible heterogeneity in patient responses.
- Addressing diversity and equity in formulary development, such as by incorporating robust health outcomes data by racial and ethnic group into formulary development tools.
- Evaluating systems such as benefit offerings through a lens of increasing equity (acknowledging patient differences), instead of equality (treating all patients the same).
- Recognizing cost-related factors that affect equity, e.g., updating benefit designs to be more flexible through variable cost-sharing and premiums.
- Considering patients’ interactions with and ability to access the health care system to lessen any disadvantage to a particular group (for example, expanding access to digital tools).
- Committing to patient-centered care by assessing and addressing social determinants of health that affect individual patients’ health care.
Forum participants also noted the need for policy reforms to ensure incentives for payers and physicians that align with these equity innovations, as well as equity education and training for all health care stakeholders.
Once implemented, these programs and policies should be evaluated regularly using rigorous research methods to ensure their effectiveness and return on investment. For example, recent NPC research reviewed studies that evaluated the impacts of SDOH interventions and found most were poorly designed, inadequately documented, and inconsistently presented. The authors recommended implementing formal guidelines for conducting and evaluating SDOH studies that focus on the areas of design, sample size and outcomes reported. Such guidelines could help with better evaluation of equity initiatives, providing greater opportunities to improve and adjust programs and policies to meet patient needs.