A Conversation about Pharmacoequity with Dr. Utibe Essien

The healthcare industry has a key role to play in advancing health equity. Health companies can work to cultivate and sustain a system that advances equity by collaborating with care and service providers and communities, tailoring policies and programs, and supporting greater access to care. Elevance Health has prioritized three areas to drive more immediate progress of care delivery and equitable experience: maternal health, behavioral health, and pharmacoequity.  

Pharmacoequity is the idea that everyone — regardless of race, disability, socioeconomic status, geography, or other factors — has access to the most appropriate evidence-based medication indicated to improve their condition. It’s a term coined by Dr. Utibe Essien, an assistant professor of medicine, a general internist, and a health disparities researcher at the University of Pittsburgh School of Medicine.

Essien and his colleagues have published several medical studies that highlight inequities in how specific cardiovascular treatments are prescribed. Most recently, they found that among 110,000 patients within the Veterans Health Administration system who had atrial fibrillation, Black patients were up to 26% less likely to receive the latest, most effective blood thinners for stroke prevention — treatments that are now considered standard of care. We spoke to Essien about this disparity and ways the healthcare system can begin to address it.   

Elevance Health: What would you like people to learn from your work to advance health equity and pharmacoequity? 

Essien: “My research has been largely focused on racial and ethnic disparities and access to cardiovascular drugs — thinking about health equity, about pharmaceuticals, and blending these two broad themes together into this term we created. 

It’s important to really understand some of the social drivers that cause a lot of these differences. Access extends beyond insurance to include pharmacy deserts, for example, and some of the inequities that underserved communities experience.

You read a piece like this and think, Maybe doctors are just biased. Maybe people are uninsured and we just need more affordable medications. That can be the top headline, but it goes so far beyond that. I think it goes into what are the processes by which a drug converts to generic versus not? What are some of the processes behind the scenes with pharmacy benefits managers and access to affordable therapy?” 

Solving for this is a huge undertaking, as you point out. What, for example, can a health company do to address the pharmacy desert issue?

“We've seen pharmacies close all throughout the country over the last few years. What kind of support can be provided to those pharmacies, whether it's financial or otherwise, to help strengthen and keep them in place? That’s one big-picture goal. The second is working with some of the infrastructures in place. For example, there are ride-share programs and mail-order programs that can be linked to pharmacies for patients who are unable to get there to pick up a prescription. 

Lastly, it’s really connecting with members and asking, “Hey, what are your needs?” It can be something as simple as there was no one at the pharmacy who spoke my language, or the co-payment upfronts are too much for me, or I prefer to go to this pharmacy versus the other.” 

How can data audits of provider prescribing practices and innovations in electronic medical records help advance health equity? 

“Our health systems have had all these quality metrics for the last two decades, but it's always been about quality overall: How many re-admissions are you preventing? How many people are getting their hemoglobin A1C checked, or ensuring that their cholesterol levels are appropriate? But I think we need to finally embed equity into those goals.

Tracking data related to equity has really not been done nationally and in a more formal way — not to shame doctors into submission, but really to learn from how each doctor is doing or how each health system is doing.  

For me, it's always been about making the right choice also be the easy choice. What are some of these electronic medical record nudges, for example, that we can embed to help? An alert that just convinces you that this is the right medication for them: This is what the guidelines recommend. So we're not having this back of the mind conversation about, ‘Well, this patient isn't really that adherent. I know that they've had issues with X, Y, Z, perhaps they're going to struggle with this treatment as well.’” 

Have you been surprised by the extent of the health-related inequities that you’ve found in your research?

“During the whole journey, we’ve kept fine-tuning the hypothesis and saying, “Well, our first hypothesis is that racial and ethnic disparities would exist in prescribing for this new therapy. But maybe if we do take away issues around insurance, that would get rid of the problem — issues around co-payment, issues around access to a primary care doctor or a cardiologist.” The VA really seemed like the perfect playground for this question, where medications are $5 to $11 regardless of who you are, and veterans across the country have access to the same medication formulary. But we did see inequities, and we saw them be super consistent with our prior two studies in this space. So it was definitely alarming.” 

How does pharmacoequity fit into the broader health equity space? 

“As a primary care doc, I’m all about prevention, and that prevention, I think, extends way beyond pharmacoequity. So while we think that pharmacoequity is a critically important area to achieving health equity, it by no means addresses the systems and structures that have been in place for decades, if not centuries, that have been really evading health equity around the public health and prevention spaces.

I feel like I am starting to carve a niche in this medication-equity space with my colleagues who are studying across the board. But it is not the be-all-and-end-all of health and equity. I'm looking forward to continuing to work with folks around some of these other spaces to make sure that we can just live healthier, longer lives.”

This interview has been edited and condensed for clarity.