Two Medical Refrigerators Bolster Health Care for Uninsured Patients at a Virginia Charitable Pharmacy

Medical refrigerators, donated by Sanofi and distributed to U.S. nonprofit healthcare providers, are strengthening Direct Relief’s pharmaceutical replenishment program.

Pharmacists at CrossOver Healthcare Ministry were excited to participate in Direct Relief’s long-standing ReplenishRx program when a staffer asked them an unexpected question: “Do you have enough refrigerator space for all your patients?”

The answer: It’s complicated. CrossOver, a charitable pharmacy in Richmond, Virginia, provides its services — medical and dental visits, labs, social work, and Medicaid enrollment assistance, along with prescription medications — entirely through volunteer time and donations. Although they’ve been a Direct Relief partner for more than a decade, their facilities were too small for a long time to house all the medications, let alone the cold-chain medicines like insulin, that their patients needed.

Now, they were in a larger facility, but medical refrigeration was an ongoing challenge. Getting enough insulin for patients was, as CrossOver CEO Julie Bilodeau termed it, “chaos.” Insulin supplies were unpredictable and took up to 12 weeks to come in. “We were finding we had to switch people from one insulin to the other,” she explained.

For CrossOver’s pharmaceutical staff, this wasn’t ideal. The pharmacy offers medications to low-income, uninsured patients who have “a much higher incidence of chronic disease,” Bilodeau explained. “Helping patients manage diabetes is really critical for us.”

Joining the ReplenishRx program, which offers U.S. healthcare partners access to a wide range of prescription medications, including commonly requested medications for chronic diseases like diabetes, was a game-changer for them. But with about 1,000 patients with diabetes registered at the pharmacy, storing enough refrigerated insulin to meet each person’s need — consistently — was a challenge.

Direct Relief offered an additional, supportive donation: two pharmaceutical-grade refrigerators from healthcare company Sanofi, which collaborates with the organization. In total, Direct Relief was distributing 32 medical refrigerators, which maintain and monitor highly consistent temperatures to safeguard cold-chain medications and vaccines, to replenishment partners across the U.S.

“The refrigerators allowed us to join the program,” Bilodeau said. “Without [the donation], we would have had to delay and raise significant funds” to be able to store enough insulin to meet patient needs.

Amiyah Newsome, medications program manager at CrossOver, said the refrigerators have made it possible to offer patients who need insulin 90-day prescriptions rather than only being able to provide 30 days at a time — making it more likely patients will have access to and reliably take their medication. They’ve also made it possible for CrossOver to add about 25 new medications to its formulary — the list of prescription medicines available to patients.

Newsome recalled a recent patient with no insurance who was overdue to see a provider — and whose A1C levels, a measure of blood sugar used in diagnosing diabetes, were “not in a safe range.” The insulin he needed was available in CrossOver’s new medical refrigerators, and “he was able to get seen by the provider and get his prescription filled all in one day,” she said.

For Bilodeau, the access the ReplenishRx program provides — and the medical refrigerators that make participating possible — are key to the pharmacy’s mission: “Our mission really is to provide access to health care to people who, without CrossOver, would not be able to access care,” she explained.

But fulfilling that mission in the face of growing demand isn’t always easy. “We’re at capacity. We’re turning people away,” Bilodeau explained. “There’s a tremendous amount of need,” especially, she said, in Richmond, where many people who can’t afford to live in Washington, D.C., settle in the hope of finding an affordable place to live.

CrossOver staff have seen patients from about 150 countries, and Bilodeau said current patients speak between 30 and 40 languages. “That’s kind of built into our DNA: All are welcome,” she explained.

While cold-chain storage isn’t always a widely publicized need, Bilodeau said many nonprofit healthcare providers can’t afford to store all the refrigerated medications their patients need. While many clinics and charitable pharmacies rely primarily on volunteers and donations — all of CrossOver’s pharmacists are volunteers, for example, and the pharmacy relies on external medication donations to stock its shelves — meeting logistical needs often poses a unique challenge.

“A number of clinics are having trouble finding refrigerators like this,” Bilodeau said.

During the past two years, Direct Relief has provided CrossOver Healthcare Ministry, a partner since 2011, with more than $738,000 in medication support, including insulin and other chronic disease medications.