There is Significant Potential for the Pharmacist in a Food as Medicine Prescription System

Pharmacy Times is honored to be joined by Holly Freishtat, the senior director of Feeding Change at the Milken Institute, at the National Association of Chain Drug Stores (NACDS) Total Store Expo in San Diego, happening August 12 through 14, 2023. Freishtat provides a macroscopic view of food is medicine, adressing how the principle combines prescription foods with prescription medication to improve outcomes for those with diet-related disease and/or face food insecurity, and Freishtat elaborates on the growing body of research suggesting pharmacists can be a critical part of scaling this sytem.

PT Staff: Could you discuss the principle of food is medicine? How can address chronic disease and work within the larger healthcare system?

Holly Freishtat: So when I think about food is medicine, or I would say food is medicine prescriptions, it's really looking at [or asking], “How do we pair healthcare, and treatment with food?” So it's a prescription. So if you have a diet-related disease and you go to your doctor, just imagine it doesn't exist quite like this yet. But if you went to your doctor or your health care provider, and they're asking screening questions. “Are you food insecure? Or have you missed some meals?” And so the person says, “Yes, I'm food insecure.” And then the health care worker then says, “Well I can see that you have diabetes. And because you are food insecure as well, what we would really like to do is prescribe a diet that goes with a treatment plan.”

So this is kind of where I work, I'm vision-casting for you. And just imagine that you would leave the doctor and be able to get a prescription. And so there's many kinds of food prescriptions right now. There is medically tailored meals. So you could have medically tailored meals [which] is 1 type of prescription, and medically tailored groceries is another type of prescription. A produce prescription. All right. And so one of the things that we think about—we're talking about actual prescription though—[or] what we're hoping for is this day and age where we have food prescriptions that are readily available to those who need it with a health condition, and that you would get a flu prescription to be part of your treatment plan.

And imagine if you insurance company or insurance plan could be reimbursing and paying for those expenses to go with your treatment plan. So that it's a part of treatment. So right now, when we think of food and when we think about underserved communities and food insecure communities, we think of food access, right? We think about providing nutritious foods. But access alone is not enough. Like if when we know that people have health conditions, we want to make sure not only that they have access, but [access] to the right foods for their health condition. And just imagine if it was part of your health treatment plan. So when we talk about food as medicine prescriptions, we're talking about this concept of continuum of care.

So when we think about food as medicine interventions and prescriptions, we're talking about how it's tied into healthcare. And the reason why I'm staying focused in that area is that when we think about food is medicine at large, it's really important. But I'm coming from this perspective. I worked for the city of Baltimore, as a chief of food policy and planning for almost 12 years I had the really the honor to serve for the providing nutrition security response during COVID-19. One of the things that we were able to see is that because during COVID-19 was really the first time—it was, I would say, if you could even say silver lining, but silver lining — that we were able to get a significant FEMA reimbursement so that we could provide 18,000 produce boxes a week at 90 sites for 2 consecutive years, along with many other nutrition security responses in the city. And what we saw is that people were eating fruits and vegetables because they were getting it every single week at their community location and it was free.

Just imagine if we could solve for the healthcare side, like not just access, and there was this moment, I remembered, this woman came up to me and said, You know, I love I've been loving these produce boxes, you know, been eating them every night, once a week. And, and, and I'm diabetic, and I really have appreciated the bananas. And I was thinking, well, access alone is not enough that just imagine if she had the treatment plan for her produce prescription box that would guide her on which foods foods would be most appropriate to treat diabetes. And so it's not this is just one piece of a larger movement of food as medicine. And what we're trying to solve for is where's the role of healthcare? Where's the role of insurance? Where's the role for reimbursement to be able to compliment treatment plan?

PT Staff: How can the pharmacist have a role in the field of food is medicine?

Holly Freishtat: We are working (the Milken Institute)—and I should have probably started with, I'm the Senior Director for feeding change at the Milken Institute— we are working closely with the National Association of Chain Drug Stores, where we are here today and on a project. We're really starting to think through what is the role of pharmacists, and here are a few things that we know. Pharmacists, they're in communities all over this nation, right. We also know that pharmacists have been the true heroes of vaccinations and COVID-19, and they have risen to these occasions and are at the center of the with a patient-centric approach. It's like one-on-one individual attention between the pharmacist and the person who lives in community, the patient. And so when we think about the role of pharmacists, also what we know about pharmacists, they understand how prescriptions work. They understand HIPPA compliance, they understand medications. And one of the things that when we think about food as medicine is, just imagine if you're an older adult and you're taking many medications and you're low-income. You may be having to decide between food or medicine. And so what's the pharmacists role like? The pharmacist is going to be able to see, and just imagine if the pharmacist who was screening for food insecurity and say like, “Oh, here's, here's an issue and just imagine if we had the reimbursement mechanism.”

So there could be a food prescription tied with along with the medication. So with the role of the pharmacist right now, we're starting to think this through and interview pharmacists, and see “Where is their role? Where are their greatest strengths, what are the opportunities and barriers?”

And one of the things that we've done recently, at the Milken Institute, is release a report called Market Solutions for Scaling Food as Medicine Prescriptions. And there's this great work happening in the field of food as medicine, right? It's easy to sell the idea, right. And now we're starting to see the building of the evidence. We have researchers and organizations that are really starting to build the evidence base of food as medicine. We're also seeing how community-based organizations are stepping up and being leaders in you know, running and delivering food as medicine programs.

But what we saw here was I saw a gap; we saw a gap of how's it going to be financed. Are we going to have enough money? Even if we get reimbursements, will that be enough money? How do we have blended financing to make sure that we don't only cover the cost of the food, but cost of the full service, and everything else is needed? And one of the things that we also learned in this study is the role of technology. Right now, our technology systems are not in place to be able to scale food prescriptions, and we don't have the right funding mechanisms. So, the support that we've done is really looking at how do we look at these details of technology, and making sure that the data and the reimbursements actually can happen. And so that's what we're building off that work and now applying that to how does this tie into pharmacists?

How do we make sure that the data and the reimbursement and these mechanisms can be able to cross from the pharmacist to the insurance company, to the grocery store, but also the person right and easy, really easy for the person to be able to use their card, and you'll know exactly what foods they can buy, how this prescription is going to work and make it easy for them. And so right now we're on this cusp of opportunity of how we really transform with technology and financing and all the other research and partnerships in this nation to really bring food as medicine to scale.