Cracking the code on social determinants of health: the essential role of market access

Cracking the code on social determinants of health: the essential role of market access

By Elisa Remoundos, senior VP, group creative director, Entrée Health

Many pharmaceutical companies listed strategic objectives for 2024 that included solving for health inequities, clearly positioned within pillars that focused on improving or increasing the value of their products. For one reason or another, many of those objectives were set aside as planning commenced in the new year, leaving this crushing challenge to our society unaddressed.

As documented by the Kaiser Family Foundation, health disparities are driven by social and economic inequities exacerbated by racism and discrimination, including:

• Economic stability (employment, income, expenses, debt, medical bills, and support)
• Neighborhood and physical environment (housing, transportation, parks, playgrounds, walkability, zip codes/geography)
• Education (literacy, language, early childhood education, vocational training, higher education)
• Food (food security, access to healthy options)
• Community, safety, and social context (social integration, support systems, community engagement, stress, exposure to violence/trauma, policing/justice system)
• Healthcare system (provider and pharmacy availability, access to linguistically and culturally appropriate and respectful care, quality of care

Why do we as an industry continue to brush aside this pressing problem only to have it continue to be a bullet point for the next planning season?

The answer, like the problem, is not simple. Health inequities will not be solved with just one idea or one great campaign. To truly improve health outcomes for all will require a fresh approach to all clinical decisions, from developing more inclusive clinical and real-world evidence trials to crafting coverage policies that consider more than just a drug label, and also rethinking the social determinants of health (SDOH) that can have a huge impact on adherence, compliance, health outcomes, and societal burden.

The societal cost of health inequities is staggering

In 2018, a study funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, found the economic burden of health disparities remained unacceptably high.   

Healthy People 2030, launched in 2020 by the U.S. Department of Health and Human Services, is a 10-year plan that sets national objectives to improve health and well-being. The initiative focuses on health equity, SDOH, and health literacy. Healthy People 2030 divides SDOH into five core areas.

These social determinants can have a wide impact on health disparities and inequities. For example, people who live in an area without easy access to affordable grocery stores with healthy options likely have poor nutrition. This can lead to chronic and costly health conditions like heart disease, obesity, and diabetes.

While Healthy People 2030 is a newer initiative, it is a part of The Healthy People Initiative that began in 1979 when Surgeon General Julius Richmond issued a landmark report titled “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention.” Addressing these public health concerns is not new, yet it took a global pandemic to bring these disparities into the forefront of the conversation. The glaring difference in outcomes between those with access to good hospitals, telehealth, food sources, and schools vs those without was heavily apparent via social media and global news outlets. Despite “COVID fatigue,” it is imperative that market access professionals not let that exhaustion drive us away from improving health equity and impacting SDOH.

Market access as a changemaker in SDOH

Payers are actively looking for ways to address health disparities and are seeking manufacturer support in doing so. In 2021, AMCP held a partnership forum to discuss the potential sources of racial health disparities and inequities in benefit design, as these are primary drivers of medication use. A group of 40 experts across managed care identified many areas of consideration that could have a great impact on health equity, including data, formulary process, benefit offerings, and patient access.

The topics detailed above require time, energy, and resources when it comes to budget planning year over year. However, the impact will have a long-lasting effect on pharma and biotech organizations and their reputations. The time to begin is today.

The following are three market access opportunities for an equitable path forward:

1. Rethink the traditional value framework of your product.

Need + Efficacy + Safety/Cost is no longer enough to determine the value of the new, potentially high-priced entrants coming to market. The value framework needs to expand to include additional elements that could impact SDOH, such as equitable access to proposed interventions to improve health outcomes along with patient-reported outcomes that help humanize the value of a product.

2. Switch the focus from overall population to population of one.

By casting too broad a net over the entire disease state population when crafting coverage policies and designing utilization management criteria, the nuances of the individual are lost, which could lead to poor health and financial outcomes for everyone. For example, instituting specialist-only prescribing criteria impacts many in rural areas, requiring extended time off work and lost wages to travel to an approved specialist. Agencies that specialize in market access can help navigate the creation and engagement of sensible coverage policies that recognize the individuality within a large population.  

3. Patient support programs have little value if they can’t connect with patients.

When designing a patient support program the emphasis can often be on a digital program that is a part of an existing website and pushed under a tab titled “Additional Support.” What often is not thought about is whether the resources are easy to find, understand, and use—in essence, health literacy. When designing your patient support program, these factors are a must:

• Develop resources that are accessible for everyone, even those that lack digital capabilities.
• Ensure you are developing content for the patient that is clear and simple to understand; use language and design principles they are familiar with.
• Offer quick, easy-to-find answers to the most pressing questions and needs—the less search time is needed, the more likely someone will use the program.

There is no quick fix

There is no simple answer to Improving health equity and impacting the various social determinants of health; however, collectively we can start taking steps to improve the imbalance within the health care system. This means looking for ways to incorporate SDOH solutions in even the smallest of educational resources, programs, or campaigns. Let’s make 2024 the year where we shake up “business as usual” and begin to change our approach to how we better serve the populations at the center of everything we do.

Elisa Remoundos, senior VP, group creative director, Entrée Health, leads creative strategy for pharma and biotech clients, leveraging her natural curiosity and 18+ years of market access experience. She’s passionate about creating impactful stories that put faces ahead of numbers when defining therapeutic value and addressing social determinants of health in ways that meaningfully impact access to prescribed medications.