528:
Pharmacy Deserts and Healthcare Impediment Zones
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Bruce L. Wolf, MD FAAAAI, Michael Becker
RATIONALE: Medications are extremely expensive and increasingly so. “Pharmacy deserts” are areas where there is lower accessibility to medications due to any combination of lower median incomes, high drug prices, poor transportation, and/or long distances required to obtain lower prices.

METHODS: We examined the lowest prices of esomeprazole 40mg and captopril 25mg available in the 30 zip codes in Nashville, Tennessee (Davidson County). Prices were found through a web-based medication price transparency engine that, via discount vouchers, allows patients without insurance to pay lower prices, and often even those with insurance. Prices are often dramatically lower than average wholesale prices. Then, median incomes of each zip code were juxtaposed to see if those with less income are disproportionately affected depending upon where they live.

RESULTS: Both prices and distances vary widely depending on location. For esomeprazole, four of the highest nine prices by zip code were found in the five lowest median income zip codes. The highest prices of captopril were in areas where patients must travel 6-10 miles to access the cheaper medications.

CONCLUSIONS: “Pharmacy deserts” exist because of a variety of factors. Creative strategies are needed to help people access their medications. One idea is an Amazon-like drug-shipping program linked to a medication price transparency engine bringing the lower priced medications to areas where they are more expensive. Overall, “pharmacy deserts” should be thought of more broadly as part of healthcare impediment zones (HIZ) – necessary targets for politicians and healthcare architects.