Title:
Pharmacist-Led Streamlined Medication Access for high Risk patienTs (SMART) Charitable Care Formulary at Discharge: A Pilot StudyAuthors:
Shay Roth, PharmD, BCPS; Dannielle Brown, PharmD, BCPS; Erin VanMeter, PharmD, BCACP; Robert Green, PharmD; Rosalyn Stewart, MD, MS, MBA, FAAP, FACP; Meghan Swarthout, PharmD, MBA, BCPS, CPEL, FASHP; Lisa Lagana MSN, BSN, RN, CCM, CPHQ, NEA-BC; Caitlin Dowd-Green, PharmD, MBA, BCPS, BCACP
Objective/Background:
To expand the SMART Formulary, a charitable care program that assists patients with affordability barriers to medication access, from the ambulatory to inpatient setting with the goal of improving outcomes and reducing avoidable healthcare usage.
Methods:
- Adult patients admitted to an internal medicine service between August 1, 2025 to September 30, 2025 were eligible for enrollment in the SMART Formulary Pilot Program. Currently , a 30-day medication “voucher” is provided by case managers/social workers at the request of providers for discharging patients to cover medications that are unaffordable. However, no workflow currently exists for consideration of therapeutic alternatives that could be clinically appropriate and financially sustainable. Clinical pharmacists proactively reviewed voucher requests and medications prescribed at discharge for patients with affordability barriers, and recommended sustainable therapeutic alternatives or aided in identifying sustainable means of access, such as patient assistance programs (PAPs). Patient demographics, medication-specific information, and re-presentations within 90 days of discharge were collected and compared to historical data from August 1, 2024 to September 30, 2024.
Results:
- Of 37 patients enrolled, 35.1% were uninsured. The pilot yielded 50 pharmacist interventions, including initiation of 12 PAPs.
- Compared to historical data, The SMART Formulary Program significantly reduced the average number and cost of medications provided via voucher per patient from 4.74 to 2.03 and from $192 to $71, respectively. The program reduced the total amount spent on medications via voucher overall ($6708 to $2637) and total cost covered by voucher for medications with more sustainable means of access ($4088 to $355). The intervention cohort had more re-presentations to the emergency department (ED) as opposed to hospital re-admissions, with lower overall estimated cost of care.
Conclusion:
The program yielded an estimated $126,205 cost reduction over the two-month period driven by optimized medication access and shifting use from high‑cost hospitalizations to lower‑cost ED visits for 90‑day re‑presentations. The SMART Formulary Pilot Program demonstrated meaningful patient impact and cost avoidance, emphasizing the value of clinical pharmacist oversight of charitable care spending to ensure optimized and sustainable medication therapy and improved outcomes.
Self Assessment Question:
Which of the following is a benefit to implementing clinical pharmacist oversight of charitable care program spending for patients at hospital discharge?
Decreased emergency department re-presentations within 90 days
Decreased mortality at 90 days
Increased prescribing of financially sustainable medicationsIncreased prescribing of generic medications compared to branded medications
