Growing up, one of my biggest frustrations with the healthcare system was seeing second-hand experiences where language barriers would constantly arise and create innate disadvantages to the care that some of my family members would receive. The most frustrating part was how simple some of the issues were, and how much more complex they became when a language barrier existed. I never realized the impact I could have on health disparities until I began working in the field of pharmacy.
On my ambulatory care experiential rotation with Dr. Gonzalvo at Eskenazi Health, I had the opportunity to work in a cardiovascular risk reduction clinic, where we focused on managing patients who had diabetes, hypertension and dyslipidemia in an effort to reduce the likelihood of them experiencing a major cardiovascular event as a result of these conditions. One of the unique things about this rotation, is that on Mondays and Tuesdays, we saw primarily Spanish-speaking patients. With Spanish being my native language, this was an experience that I had been looking forward to for a long time. The nature of the ambulatory care clinic called for face-to-face interactions with patients. Due to the COVID-19 pandemic, this experience was shifted to a virtual platform, which creates a new multitude of barriers to many patients. It also gave me as a learner the opportunity to have autonomy in calling patients to perform a medication reconciliation and obtain a better clinical picture. Nonetheless, there is one experience that stuck with me.
One of our patients was a 53-year-old Latino male who I will call AR from now on. AR worked alternating first and second shifts, and his work schedule made it hard for us to get a hold of him on some days. He had a most recent A1c of 8.6% and had been prescribed Tradjenda and metformin for his diabetes, lisinopril for his hypertension, and atorvastatin for his dyslipidemia. Once I was able to get a hold of AR, he made it very clear how thankful he was that I was able to communicate with him in Spanish, as this had been an issue for him in the past with understanding his medications and communicating his troubles with taking them. Upon further questioning, I was able to verify that the only medication AR had been on in the past 6 months had been his metformin – all of the others had been too expensive, especially his Tradjenta. In talking through the importance of the medications, and explaining how they work, why they were prescribed and how they should be taken, the patient told me that he wanted to be on the medications, but that the most he could afford a month was around $20. I told the patient I would look into this for him.
Once I dug deeper, I discovered that the patient had undergone a change in his insurance coverage, and that his pharmacy had not been billing the correct insurance. I also discovered that Januvia was his preferred antidiabetic medication. After requesting that the pharmacy run the medications through his insurance, the copay was still more than what I knew the patient would be able to afford. So, I went online and searched for a manufacturer’s coupon card for the patient. It required some information from the patient, so I called him back the next day once he got off his second shift from work and explained what I was doing and what I would need from him. Once I had all the information, I called the pharmacy back and requested they re-run everything through. At the end of it, what originally was going to cost the patient over $500 a month, we were able to get it down to $6.86 a month for all of his medications. I almost couldn’t believe the difference. I called him back to explain what I had done, and what the new price would be. I also assisted him in getting his medications set up for delivery (free of charge) so that he would not have to worry about making trips with this varying work schedule. AR was also in shock and mentioned that no healthcare professional had ever gone to this extent to help him, and how thankful he was.
It was through this experience, that I found something that I am passionate about – serving the underserved, addressing factors that contribute to health disparities, and breaking down barriers that exist which prevent us from delivering exceptional patient care. I knew what it was like to not be explained everything, simply because of a language difference. I have known healthcare providers who have gone above and beyond, and those that have been okay with doing the bare minimum. Knowing that at the end of the day, we do what we do to help the patient, why would we not go above and beyond? Why not take those extra steps to ensure the patient has access to medications? These are some of the health equity issues that I hope to make a difference in throughout my professional career. I hope to be able to implement change to breakdown some of these barriers. I know it is not an easy process, but I believe it is a necessary one. I won’t get to follow AR as a patient throughout my professional career – I will not have the satisfaction of seeing a potential A1c drop as a result of him actually being on the appropriate medications, and that is perfectly okay. At the end of the day, I did exactly what I was supposed to do – serve the patient and help fix a small piece of a broken system.
Moises Martinez, 2021 PharmD Candidate