Cost and Access Access and Coverage
RRM Academy Synopsis
Two infertility drugs were less available in minority NY areas
A phone survey of 121 New York pharmacies found that two infertility drugs were in stock less often in mostly minority areas. The authors suggest low stock may hurt compliance and delay referral to a subspecialist.
Key Findings
- The authors hold that gaps in availability, with no rise in price, may "adversely affect compliance," leading to suboptimal treatment and later referral to a subspecialist.
- Clomiphene citrate was stocked less often at Bronx pharmacies (79 vs. 89%, P<0.01), where over 80% of residents are black or Hispanic. Choriogonadotropin alpha was absent there (0 vs. 15%, P<0.01).
- Stock of both drugs trended down when the share of black residents climbed from 10 to >40% (53 vs. 33%, P<0.01). Rising white share brought no change.
- Choriogonadotropin alpha prices fell as the black share grew ($133 ± 14 vs. $99 ± 10, P<0.01), and clomiphene citrate prices showed a downward trend.
Interpretation
Researchers called 121 pharmacies in the Bronx and Westchester County, New York. They checked the price and stock of 15 common fertility drugs. Then they compared the results by the racial makeup of each ZIP code. Two drugs were harder to find in mostly Black and Hispanic ZIP codes. One drug's price actually fell as the Black population share rose. The authors say these access gaps may delay referral to a subspecialist. They say this may lead to worse treatment for patients in minority communities. The findings support larger studies of how pharmacy access affects fertility care in different communities.
RRM Context
Restorative reproductive medicine looks for the cause of infertility before treatment starts. Access to medication and referral should not depend on where a patient lives.
Abstract
Objective
To determine if disparities in cost and access to commonly prescribed infertility medications exist in predominately minority neighborhoods.
Design
A prospective phone survey of pharmacies in Bronx and Westchester counties of New York State was done to assess the availability and cost of commonly used infertility medications. Demographic data for each county was defined by U.S. Census Data. Pharmacies were categorized by ZIP code and the availability and cost for medication determined and compared to the racial composition of that ZIP code.
Materials and Methods
121 pharmacies were surveyed. Availability and cost of 15 medications commonly used to treat infertility were obtained. Data were stratified by racial demographics and analyzed with Fishers exact test, ANOVA, or Chi-square test for trend.
Results
Reduced availability of Clomiphene citrate (CC) was observed in the Bronx pharmacies (79 vs. 89%, P<0.01), an area populated by >80% blacks and Hispanics. Choriogonadotropin alpha (CGa) was not available in the Bronx (0 vs. 15%, P<0.01). There was also a significant decrease in the trend for the availability of both CC and CGa when the percentage of blacks increased from 10 to >40% (53 vs. 33%, P<0.01) compared to no change for increasing percentage of whites. In contrast the availability of CGa was highest in areas with > 80% white compared to areas with >40% black or Hispanic (15 vs. 0%, P<0.01). Interestingly as the percentage of the black population increased the cost of CGa significantly decreased ($133 ± 14 vs. $99 ± 10, P<0.01) and there was also a trend for reduced CC costs.
Conclusion
Racial disparities in infertility outcomes are linked to delayed treatment and referral patterns or inadequate access or utilization of subspecialty care. These data suggest disparities in the availability of commonly used medications but not increased cost may adversely affect compliance and contribute to suboptimal treatment and delayed referral to subspecialist.
