Pharmacoequity: An Introduction

Author: Jasmyn J. Tang, MPH

April 25, 2025

In 2021, Dr. Utibe Essien, MD, MPH, coined the term pharmacoequity, an idea that all individuals, regardless of race/ethnicity, gender, socioeconomic status, etc., have access to the most appropriate medication for their condition.[1,2] Dr. Essien is a board-certified general internist and an Assistant Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) and an investigator in the Center for the Study of Healthcare Innovation, Implementation, and Policy at the Greater Los Angeles Veteran Affairs (VA).[3] He also serves as Assistant Vice Chair of Community Engagement and Inclusive Excellence in the UCLA Department of Medicine.[3] His research focuses on racial and ethnic disparities in the use of novel medications and technologies, especially in the treatment of cardiovascular diseases like atrial fibrillation (AF).

Achieving pharmacoequity and improving health equity in general is no simple process. It’s a complex network of factors that continuously influence patients and their providers. One common complicating factor is cost. In the United States, individuals spend more than $1,100 annually out of pocket on health care, with minority populations having a higher likelihood of insufficient insurance, greater rates of cost-related delays in care, and lower access to high-quality medication.[4] A prior study on physical pharmacy closure among adults 50 and older found a significant decline in medication adherence during the first 3 months after closure, which persisted over 1 year.[5,6]

Access to care and racial bias greatly impact patient care and equitable treatment. The US has taken approximately seven years longer than the UK to make generic medications available, which leads to more affordability for patients.[2] Under the Affordable Care Act, 10 states (i.e. Wyoming, Kansas, Texas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina, and Florida) have yet to adopt the expansion of Medicaid, where states would accept additional federal funding to provide more health coverage to low-income adults.[7] In a 2021 University of Southern California (USC) study, pharmacy deserts are disproportionately more likely in Black and Hispanic/Latino neighborhoods than White or diverse neighborhoods, limiting prescription accessibility and healthcare services.[8,9] Implicit bias, or subconscious perceptions, continuously persists in medicine, with Black Americans receiving treatment clouded with false assumptions about their ability to adhere to, tolerate, and warrant medical therapies.[9,10] Though these biases are recognized, bias-driven practices and policies still negatively affect patient care, medical training, diversity of the healthcare workforce, and diagnostic uncertainty.[11]

As patients and providers navigate their way to achieving health equity, a pharmacoequity measurement framework was created by Dr(s). Pranav M. Patel, PharmD, MS; Utibe R. Essien, MD, MPH; and Laura Happe, PharmD, MPH, FAMCP in 2024.[12] Anchored in a patient’s medication-use journey, this framework, as seen below, highlights equitable access to medications through metrics for: 1. Access to Health Care Services, 2. Prescription Generation, 3. Primary Medication Nonadherence, 4. Secondary Medication Nonadherence, 5. Medication Monitoring.[12] This framework is not limited to pharmacoequity, but a foundation for future research and policies to combat health inequities.

Improving health systems and health plans in communities while communicating with providers about bias and patient costs are crucial. Achieving pharmacoequity would be one of the pinnacles of success in healthcare. With adversaries, like bias, healthcare coverage, medication regimen, etc., standing in the way of reform with decades of deep-seated cultural influences, pharmacoequity is a pillar for equitable transitions in healthcare practices today.

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Glossary

• Atrial Fibrillation: AF is an irregular and often very rapid heart rhythm. which can lead to blood clots in the heart and increase the risk of stroke, heart failure, and other heart-related complications

• Implicit Bias: A negative attitude, of which one is not consciously aware, against a specific social group that can be shaped by experience and based on learned associations between particular qualities and social categories, including race and/or gender.

• Medication Adherence: Taking medication as directed by a healthcare professional, pharmacist, etc.

• Pharmacoequity: Ensuring all individuals, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest-quality medications required to manage their health needs.

• Pharmacy Desert: Communities where residents face significant barriers to accessing pharmacy services and medications.

• Veteran Affairs: The United States Department of Veterans Affairs provides healthcare services to eligible military Veterans, families, caregivers, and survivors.

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Sources

1. A Conversation about Pharmacoequity with Dr. Utibe Essien. Elevance Health. June 28, 2022. Accessed March 24, 2025. https://www.elevancehealth.com/our-approach-to-health/health-equity/a-conversation-about-pharmacoequity.

2. Outterson A. Doctor-Scholar Strives for ‘Pharmacoequity’ to Achieve Medication Access for All. BU School of Public Health. September 30, 2022. Accessed March 24, 2025. https://www.bu.edu/sph/news/articles/2022/doctor-scholar-strives-for-pharmacoequity-to-achieve-medication-access-for-all/.

3. Utibe Essien, MD, MPH. UCLA Health. Accessed March 24, 2025. https://www.uclahealth.org/node/185646.

4. Essien UR, Dusetzina SB, Gellad WF. A Policy Prescription for Reducing Health Disparities-Achieving Pharmacoequity. JAMA. 2021;326(18):1793-1794. doi:10.1001/jama.2021.17764

5. Qato DM, Alexander GC, Chakraborty A, Guadamuz JS, Jackson JW. Association Between Pharmacy Closures and Adherence to Cardiovascular Medications Among Older US Adults. JAMA Netw Open. 2019;2(4):e192606. Published 2019 Apr 5. doi:10.1001/jamanetworkopen.2019.2606

6. Advancing Health Equity: What Is Pharmacoequity? Elevance Health. June 28, 2022. Accessed March 24, 2025. https://www.elevancehealth.com/our-approach-to-health/health-equity/advancing-health-equity-what-is-pharmacoequity.

7. Neukam S. These 10 states have not expanded Medicaid. The Hill. March 23, 2023. Accessed March 24, 2025. https://thehill.com/homenews/state-watch/3914916-these-10-states-have-not-expanded-medicaid/#:~:text=Ten%20states%20have%20yet%20to,planned%20for%20later%20this%20year.

8. Guadamuz JS, Wilder JR, Mouslim MC, Zenk SN, Alexander GC, Qato DM. Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007-15. Health Aff (Millwood). 2021;40(5):802-811. doi:10.1377/hlthaff.2020.01699

9. Essien UR. Pharmacoequity: A new goal for ending disparities in U.S. health care. STAT. July 28, 2021. Accessed March 24, 2025. https://www.statnews.com/2021/07/28/pharmacoequity-new-goal-ending-disparities-us-health-care/.

10. Villarosa L. How false beliefs in physical racial difference still live in medicine today. The New York Times. August 14, 2019. Accessed March 24, 2025. https://www.nytimes.com/interactive/2019/08/14/magazine/racial-differences-doctors.html.

11. Sabin JA. Tackling Implicit Bias in Health Care. N Engl J Med. 2022;387(2):105-107. doi:10.1056/NEJMp2201180

12. Patel PM, Essien UR, Happe L. Pharmacoequity measurement framework: A tool to reduce health disparities. J Manag Care Spec Pharm. Published online December 20, 2024. doi:10.18553/jmcp.2025.24298