The Public Health Council, in partnership with Dartmouth Hitchcock and Alice Peck Day Memorial Hospital are excited to announce the availability of “Finding a Path to Affordable Prescription Medications: A Resource Guide.” This tool will help individuals and their trusted health advocates develop a plan for getting the medications they need at a reasonable cost.

The frontiers of science seem to expanding every day, and now more than ever before, our health care system can offer life changing and life saving medications. However, the cost of prescription medications is also on the rise. This spring, a report from IMS Health found that the list price of drugs increased 12 percent in 2015, which is in line with a 5 year trend of increasing cost. Insurers and pharmacy benefit programs still demand deals from drug manufacturers, which decreases a drugs effective cost. In fact, the net price growth – what insurance companies or employers actually pay, has only risen 2.8 percent. However, the burden of increasing drug costs is felt most by those least able to pay. Uninsured people often are asked to pay the full list price, and even insured individuals are required to pay a significant percentage of the list price. Notably, cost exposure (in the form of co-pays and pharmacy deductibles) for patients with commercial insurance has increase over 25 percent since 2010.

If you or someone you know is struggling to pay for your prescription medications, you are not alone. The PHC heard from community members and providers alike that the financial burdens of prescription medications were impacting the health and well-being of the Upper Valley. Additionally, we heard from healthcare providers and social service organizations that, though there are many potential solutions for someone who has unaffordable medications, sorting out the best options for that individual is a challenge in itself. Certain programs may be especially helpful for one class of medications, but not others. Some are only available in one of the states in our region, and others have specific eligibility requirements.

To address these challenges, the PHC set out to sort through the various resources that can help someone pay for their prescription medications. We compiled information on national, state and regional programs to find the best tools available in the Upper Valley. We also spoke with community health care and social service organizations to learn from their expertise – we asked, what programs were they using, who could access them, how does someone decide what is best for their needs and where are the gaps?

The result is “Finding a Path to Affordable Prescription Medications: A Resource Guide.” This tool is intend for case managers, community health workers, community nurses, clinicians, and others to use in partnership with someone who is having difficulty paying for their medications. It begins with a self-assessment to help the health advocate and the individual determine their needs and their options. Then, it offers resources that include local provider programs, community supports, insurance options, medication assistance programs and pharmacy programs. Finally, it outlines a planning tool for the individual and advocate to use to identify short term and long-term strategies for making medications affordable. You’ll find this guide out in the community soon!

For the past 18 months, Emma Hartswick, one of the student interns profiled in this article, has worked with the Public Health Council as an Upper Valley Social Entrepreneurship Fellow from the Dartmouth Center for Service. She has been a real asset to our work and we look forward to having her back on staff after what sounds like a wonderful summer in Boston. — Alice Ely

Article Written By Charlotte Albright (Used with Permission)

Twelve students spent the summer in Boston on the front lines of public health. As participants in a 10-week program sponsored by Dartmouth Center for Service in partnership with Dartmouth Partners in Community Service, they interned in community health centers and other nonprofit organizations, serving the city’s most vulnerable populations—people living on the streets or in shelters, refugees, and low-income families.

“All of our internship programs seek to develop leaders capable of meeting social challenges in either the public or private sector,” says Tracy Dustin-Eichler, the assistant director for nonprofit careers at the Center for Service. “Boston is a hotbed for innovative solutions to pressing health care problems.”

Learning How to Help

Intern Emma Hartswick ’17 began most workday mornings at a foot clinic run by Boston Health Care for the Homeless in St. Francis House, a daytime shelter that offers a wide range of social services. Interns and local nursing students do triage, caring for tired and damaged feet, which can flag more serious health problems that might otherwise go undiagnosed—especially in homeless people.

In a small, windowless room with a few chairs, soaking basins, and a supply cabinet, Hartswick greeted clients and posed a few basic questions—names, ages, health issues—before offering socks, anti-fungal foot powders, and soothing  creams.

A middle-aged man limped in, sat down, took off his shoes, and soaked his feet in a basin as Hartswick rummaged in a drawer for white cotton socks. He said it was exhausting, walking the streets of Boston in all kinds of weather, using a cane.

“They help take care of my feet here,” he explained. “They take my blood pressure, too, and I appreciate the kind words they have to say.”

Hartswick also worked in two other community health clinics, doing intake assessments and providing child care for patients.  A sociology and biology major, she’s thinking of attending medical school and is considering a master’s degree in public health.

“I am really interested in the social determinants of health, in the intersection of somebody’s life circumstances and their overall wellbeing,” Hartswick says. She often chats with homeless people as she walks through Boston Common to St. Francis House. “People assume they are unemployed, but a lot of them are working—they just can’t afford housing,” she says.

Connecting Students and Alumni

In addition to placing students in clinics, the Center for Service connects them with Dartmouth alumni working in medicine. Each intern is paired with an alumni mentor. Once a week, the 12 interns, who lived in dorms rented from Boston University, gathered for a dinner seminar, either to make presentations and share stories about the places where they are working, or to listen to a talk by a leader in health care or public policy.

“Local alumni are key co-educators with us in this program,” says Dustin-Eichler. A larger alumni group, called Dartmouth Partners in Community Service, provides funding and mentoring connections for this and other internship programs.

In a downtown office building one warm night, the interns met Joshua Greenberg ’86, vice president of government relations at Children’s Hospital, and Jay Gonzalez ’93, the CEO of CeltiCare Health Plan. Both men have been forceful advocates for broadening access to affordable health care in Boston.  Gonzalez served as budget chief for Massachusetts during the governorship of Deval Patrick, chairing the board of Health Connector, which was a model for the Affordable Care Act. He traces twists and turns in his career path, advising interns to consider public service.

“If you have the chance to work in government,” he advised the students, “do it. And if you can prove you can take on any responsibility, you will get it, and then some. The opportunity to really have an impact on people in the public sector is unlike anywhere else.”

Seeing Policy in Practice

Some of the interns are more interested in health policy than in hands-on care. For example, at DotHouse Health, in Dorchester, Arvind Suresh ’19 and Yingna Wang ’17 updated patient and provider lists. They also worked on an app to help patients find social services.

The interns shadowed doctors, which, for Wang, was eye opening, especially regarding the impact electronic medical records are having on medical practice.

“I think it’s really important for policy people to understand what doctors do on a daily basis, and I will take that understanding with me as I pursue a career in public health,” Wang said.

Suresh gathered data about a device being used on a trial basis to determine an infant’s height. As each baby lay on a tabletop measuring board, Suresh watched a nurse use sliders to mark the head and feet. He was trying to learn whether this method is more accurate than the clinic’s current practice of using markers and paper to measure babies.

“I am learning so much about public health from different perspectives. We’re also seeing what are the most important issues that we can take on in the future,” Suresh says.

That future will present challenges as public health care workers try to meet the needs of an increasingly diverse population. About one-third of the clients at DotHouse are of Vietnamese descent. There are also many Spanish speakers.

“Providers here are very aware of language and cultural barriers to health care,” said Wang. She and Suresh made sure that the practical tips about health and wellness they post on waiting room bulletin boards get translated into several languages.

For Suresh, managing that flow of multi-lingual information has deepened his understanding of the challenges patients in this clinic face—not just health problems, but other issues, like housing and employment, which affect their wellbeing.

“It’s extremely interesting to see how everyone here needs to think about all the things that other people need and prepare for that every day,” Suresh says.

The full list of summer community health interns:

• Yingna Wang ’17, DotHouse Health
• Aneeq Chaudhry ’19, Health Resources in Action
• Daniel Finch ’17, East Boston Neighborhood Health Center
• Emma Hartswick ’17
• Arvind Suresh ’19, DotHouse Health
• Wafaa Ahmed ’17, Codman Square Health Center
• Angela Liu ’17, Baraka Community Wellness
• Allessandra Ledoux ’17, Codman Square Health Center
• Noah Manning ’17, Health Leads
• Allyson Block ’19, East Boston Neighborhood Health Center
• Amrit Ahluwalia ’19, The Boston Living Center
• Margo Putnam ’19, The Women’s Lunch Place

Editor’s Note: Charlotte Albright is a writer in the Dartmouth College Office of Communications. This story was originally published on Dartmouth News, the college’s news website. The photograph is by Robert Gill, who also works in the Communications Office.