In the U.S., those who can’t afford their medications often go without them.

Most pharmacies charge for prescription drugs and, unlike hospital emergency rooms, “if you don’t have the money, you get turned away,” said Rusty Curington, the Director of Pharmacy at St. Vincent de Paul Charitable Pharmacy (SVDP) in Cincinnati, Ohio. For some patients, “It’s the choice between I’m going to pay my rent…or I’m going to take my drugs,” he said.

Curington works at one of a few hundred charitable pharmacies across the U.S. These pharmacies, which are members of the National Association of Free and Charitable Clinics, provide medication for free to patients who are low-income or uninsured. “I have people who drive an hour to pick up their meds because it’s cheaper than paying for the pharmacy that’s within five minutes,” he said.

In Charlotte, North Carolina, Dustin Allen has filled prescriptions for uninsured patients who have gone months without taking their medications. “People have cried out of just a sense of relief,” said Allen, the Pharmacy Manager at NC MedAssist, a free and charitable pharmacy that services all of North Carolina.

For some, especially those with a chronic condition, going without a medication can have both short and long-term consequences. “If it’s somebody that has high blood pressure, for example, and they’re not taking their medications because they can’t afford it, they may not notice anything specifically right out of the gate, but years down the line…they could have some severe side effects,” said Allen. Long-term side effects can include heart damage and kidney failure. Other times, conditions devolve rapidly. Those with Type 1 diabetes can go into a coma within a few days of not taking insulin.

Patients that can’t afford their medications often use “the emergency room consistently to manage their illness,” said Shearie Archer, the Executive Director of Ozanam Charitable Pharmacy in Mobile, Alabama. By helping patients afford their medication, free and charitable pharmacies are preventing the need for emergent care. “We are a true medication safety net,” said Archer.

But free and charitable pharmacies do more than dispense medication. Many invest in programs that “take it a step further,” Archer said. At NC MedAssist, pharmacists track how often a patient takes their medication versus how often they are getting it filled. If someone has a three-month supply of medication, but doesn’t come in for a refill, they can “make a phone call and get in front of them” to see what issues they may be experiencing, said Allen. Sometimes it can be a lack of transportation, unstable housing, or food insecurity—all of which make it difficult for someone to prioritize their health.

At Ozanam, pharmacists are helping patients improve their conditions through medication therapy management programs. Pharmacists set up hour-long appointments with patients to answer questions and provide important information. “They’re talking to the patient about the way they eat, they’re talking to the patient about taking their blood pressure daily,” said Archer. The pharmacy also provides patients with free blood pressure cuffs, blood glucose monitors, and test strips.

In this way, pharmacies are an important point of care for many patients. While those with a chronic disease may see their doctor every 6 months, patients typically refill their prescriptions on a monthly basis. “That’s a good point for me to be able to check in with them,” said Curington. For someone with diabetes, he can ask about their “numbers” or “talk about diet and exercise and all the things that help diabetes improve.”

For Curington, these visits are a “touch point” for both himself and the patient. “Every time you’re picking up drugs, [it’s] kind of a clinical visit,” he said.