Inside the Life of a Medication Access Advocate

Inside the Life of a Medication Access Advocate

On one of my first days at my host site, I found myself reading through a document explaining prescription benefit managers, drug formularies and tiering, and rudimentary facts about Medicare and Medicaid. As my head spun trying to understand these new concepts, I thought about how few of my pre-med experiences or classes taught me much about prescription drug coverage or the pharmaceutical industry in the US.  Now, having completed eight months of service as the Medication Management Coordinator, I am grateful for the training and education that has brought me to the place I am today, where I help patients navigate medication accessibility issues every day. 

As a member of the health center’s Pharmacy Team, I have the pleasure of working with clinical pharmacists every day. Most of what I do at the Family Health Center revolves around medication access. One scenario that I see very often involves patients with Medicare insurance plans which can have a deductible up to $610. Oftentimes, patients will be prescribed an expensive medication, such as a GLP-1, and when they get to their pharmacy, the medication will cost upwards of $500. The patient will let their physician know about the high cost, and the physician will typically consult the pharmacy team. There then could be a discussion of possible alternatives based on the patient’s insurance formulary, or we may suggest the enrollment in the Medicare Prescription Payment Plan (M3P), which allows them to split their out-of-pocket costs into monthly payments.  This is just one example of how we assist with medication access, as we also utilize coupons, copay cards, and Prescription Assistance Programs to help reduce cost for our patients. However, I believe one of the most impactful parts of my service work is helping to educate people about medication coverage as well as shouldering the calls to pharmacies, insurance plans, and manufacturer programs, when possible, to alleviate some of the burden of navigating this complex system.

Another important aspect of my service includes helping coordinate a patient’s transition to using adherence packaging. Adherence packaging, or “pill packs,” are assembled by pharmacies and organize medications by day as well as time. In addition, most have a key which matches the appearance of the medication to its name and what it is for. This is especially beneficial for patients with low health literacy, but also patients with long medication lists, and those who may often forget to take their medications. 

Medications are a fundamental aspect of healthcare, yet they are not always accessible to everyone who needs them. I am so grateful for the opportunity to help patients access these medications as well as for the knowledge I have gained through this experience, which I believe will make me a better-informed physician when prescribing medications in my future career.