Rx Outreach

Unrestricted support to Rx Outreach Inc., EIN35-2378788. Recipient expenses include pharmacy procurement, dispensing, staff, systems, overhead and fundraising. Gross book expenses include in-kind inventory; c is judgmental net recipient support needed per newly supported human patient-year, not retail drug value. Patient/clinic payments and sponsors can finance services without a new donation. Unmodeled pet services and other activities cannot be silently removed from the donation numerator. The cost of medication access borne by patients, providers or other funders is not free in a societal model; the reported donation skeleton does not claim total economic cost-effectiveness.

Human health of residents of 50 states plus DC. Observed 2024 service includes Puerto Rico and Virgin Islands, which are excluded. Current pet prescriptions are not human QALYs and require separate allocation before human patient-years. No outcome-weighted territorial share is available. g=.98 is the central geographic judgment; current St. Louis Fill the Gap human patients would be within boundary, but unrestricted allocations are not all Fill the Gap.

General skeleton: Q_USA = G × (b/c) × theta × g, where theta is net cumulative QALYs produced by one additional human patient-year of medication access, including later consequences discounted once. Inspectable post-MI test only: theta = f × e × t × q + z − h. f=share with trial-like high-risk post-MI prevention; e=0.018 fewer first major vascular events per patient-year (secondary MI-FREEE rate difference); t=transport/implementation attenuation; q=discounted net QALYs per event prevented; z=net health from other mechanisms; h=incremental adverse-treatment/access burden per supported human patient-year. Price = 10c/[b theta g] for positive theta. G=10000 merely normalizes disclosure arithmetic. No extra adherence multiplier is applied to e, which already measures intention-to-treat access effects.

grossExpense2024

13936912 USD/year (observed). Original PartI line26 book-expense column, not charitable cash-disbursement column. [rxo-99024]

purchasedDrugExpense2024

3132063 USD/year (observed). Already included in book expenses. [rxo-other24]

inKindExpense2024

2690257 USD/year (observed). 2610784 inventory plus79473 other in-kind; subtraction yields proxy, not audited cash flow. [rxo-other24]

earnedRevenue2024

10516967 USD/year (observed). Prescription program revenue can fund services independently of donations. [rxo-99024]

uniquePatients2024

34740 reported people/year (observed). Dated activity sheet; not human USA patient-years. [rxo-impact24]

shipments2024

188993 prescriptions/year (observed). Varying drug classes, days supply and people. [rxo-impact24]

c

400 net unrestricted USD/supported human patient-year before financing adjustment (judgment). We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. [rxo-other24] [rxo-impact24] [rxo-clinics]

b

0.5 fraction of supported patient-years financing-additional (judgment). We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. [rxo-donors] [rxo-funder]

theta

0.0013 net cumulative QALYs/additional human patient-year (judgment). We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. [rxo-clean2] [rxo-artemis]

g

0.98 fraction of net human outcome accruing to USA residents (judgment). We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. [rxo-impact24] [rxo-pets]

e

0.018 first major vascular events prevented/patient-year (observed). Secondary MI-FREEE rate difference .128−.110. Primary endpoint not significant; not general pharmacy effect. [rxo-mifreee]

f

0.1 fraction of additional human patient-years with trial-like post-MI risk (judgment). We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. [rxo-gap] [rxo-impact24]

t

0.5 clinical transport multiplier in conditional test (judgment). Attenuates trial access contrast; zero is plausible for substitution or no improved use. Does not claim a measured50% effect. [rxo-mifreee] [rxo-artemis]

q

2 discounted net QALYs/event prevented in conditional test (judgment). Illustrative composite-event severity, recurrence and survival valuation; actual mix unavailable. Not a direct trial observation. [rxo-mifreee]

z

0 net QALYs/patient-year from other clinical mechanisms (judgment). We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. [rxo-pap]

h

0.0005 QALYs/patient-year burden in conditional test (judgment). Explicit adverse-effects/access burden; no recipient harm measurement. Retained even at t0.

cleanMedsAdherence

0.101 absolute adherence difference at2years (observed). External Canadian access experiment, not integrated adherent patient-years or QALYs; not directly multiplied into model. [rxo-clean2]

Best estimate — explicit judgment: Cost: $10K; USA QALYs: 0.015925; all-population QALYs: 0.01625. c=400; b=0.5; f=0.1; e=0.018; t=0.5; q=2; z=0; h=0.0005; g=0.98. We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced.

Post-MI clinical benchmark, not portfolio prediction: Cost: $10K; USA QALYs: 0.049; all-population QALYs: 0.05. c=400; b=0.5; f=0.25; e=0.018; t=0.5; q=2; z=0; h=0.0005; g=0.98. Algebraic benchmark only, not an estimate of Rx Outreach's recipient-level yield. One year of medication access; q includes any discounted later health consequences, not extra recurring event-years.

All additional patient-years have benchmark post-MI risk: Cost: $10K; USA QALYs: 0.21437499999999998; all-population QALYs: 0.21874999999999997. c=400; b=0.5; f=1; e=0.018; t=0.5; q=2; z=0; h=0.0005; g=0.98. Algebraic benchmark only, not an estimate of Rx Outreach's recipient-level yield. One year of medication access; q includes any discounted later health consequences, not extra recurring event-years.

Existing revenues or sponsors fully substitute: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. c=400; b=0; f=0.25; e=0.018; t=0.5; q=2; z=0; h=0.0005; g=0.98. Algebraic benchmark only, not an estimate of Rx Outreach's recipient-level yield. One year of medication access; q includes any discounted later health consequences, not extra recurring event-years.

No incremental clinical improvement, with treatment burden: Cost: $10K; USA QALYs: -0.006125; all-population QALYs: -0.00625. c=400; b=0.5; f=0.25; e=0.018; t=0; q=2; z=0; h=0.0005; g=0.98. Algebraic benchmark only, not an estimate of Rx Outreach's recipient-level yield. One year of medication access; q includes any discounted later health consequences, not extra recurring event-years.

No health gain and no additional burden: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. c=400; b=0.5; f=0.25; e=0.018; t=0; q=2; z=0; h=0; g=0.98. Algebraic benchmark only, not an estimate of Rx Outreach's recipient-level yield. One year of medication access; q includes any discounted later health consequences, not extra recurring event-years.

Counterfactual: Compare to the medication access patients would actually obtain through existing Rx Outreach sales, clinic subsidies, insurance, Medicare/Medicaid, manufacturer assistance or other cash pharmacies. [Current Medicare Part D](https://www.medicare.gov/health-drug-plans/part-d/basics/costs) has a $2,100 2026 covered-drug out-of-pocket cap, while [Cost Plus Drugs](https://www.markcubancostplusdrugcompany.com/) supplies an alternative cash/mail-order channel. These do not eliminate all barriers, but old retail sticker-price savings are not the counterfactual. An unrestricted gift could subsidize already-paid fills, replace renewed grant support, finance marketing or sustain operations rather than add patient-years. b includes that financing additionality; t captures clinical transport, not the same funding discount.

Attribution: Do not attribute all efficacy of a prescribed drug to the dispensing charity. Prescribers, patients, manufacturers, clinics and public/private payers contribute. The trial event contrast incorporates access-induced uptake/adherence rather than treatment efficacy in fully adherent patients. Pharmacy-specific clinical mix and the share of services actually expanded by philanthropy remain unknown; no claim of zero alternative care.

We adopt $400 per supported patient-year, anchored to $401 gross expense per unique patient, and 50% funding response. Our best-judgment post-MI-equivalent risk share is 10%, below the earlier 25% probe: the formulary spans broader cardiovascular, diabetes and respiratory conditions. Patient counts are not matched patient-years, so this remains a rough planning cost. Other clinical benefits remain unpriced. Zero and adverse outcomes remain possible; the quantified pathway is not a complete portfolio valuation.

Sensitivity

• At c400,b.5,g.98, required theta is0.08163265 QALY/patient-year for100000USD/10QALYs and0.008163265 for1000000USD/10QALYs. These equal about29.8 and3.0 quality-adjusted days, respectively; they are required yields, not observed gains.
• In the narrow post-MI test with e.018,t.5,q2,z0,h.0005, the1million threshold needs f≥.4812925; the100000 threshold needs f≥4.562925, impossible at those assumptions. If f.25 instead, q must be≥3.85034 or36.5034 respectively. More benefit from other classes could improve the result; unknown z must be measured rather than assumed.
• Conditional c400,b.5,f.25,e.018,t.5,q2,z0,h.0005,g.98 yields0.049USAQALY per10000USD, or2.040816millionUSD/10QALYs. Raising f to1 alone yields0.214375USAQALY, or466472.30USD/10. These are benchmarks, not bounds.
• Halving c or doubling b halves positive price; observed non-in-kind expense less earned revenue is729688USD in2024, but dividing this by all patients does not identify marginal donation cost. Receipts, duration, inventories and free-versus-paid cohorts must be reconciled.
• If t0 with h retained, additional access can have a small negative modeled net effect; if b0 there is no modeled health gain. If all relevant benefit is already achieved through another channel, do not multiply full drug efficacy by shipment count.
• Changing g from.98 to.90 raises price by8.89%; targeted in-boundary assistance could have g1. Pet allocation must first be removed from human patient-years, not assigned animal health as human utility.
• Do not multiply CLEAN Meds'10.1-point adherence endpoint by all annual recipients or extrapolate one-year blood-pressure improvement indefinitely. No direct utility conversion, broad mortality credit or downstream payer savings is included.

Unresolved inputs

• Current2025/26 full-recipient budget, purchased versus donated inventory, fundraising/service costs, earned receipts, restricted commitments and cash; audited reconciliation of the unaudited2023 annual report's inconsistent printed subtotals.
• Incremental human patient-years made possible by the next unrestricted dollars, by standard pharmacy, partner-paid and free-medication programs; use actual waitlist/expansion capacity and existing sponsor renewals.
• Days supply and persistence by unique person, drug class, diagnosis, baseline risk and preexisting cost-related treatment interruption; separate pet recipients and PuertoRico/VirginIslands outcomes.
• Usual-care medication acquisition from insurance, manufacturer assistance, clinics and alternative cash pharmacies; estimate genuinely additional appropriate use without double-counting funding and adherence.
• Clinical event rates/utility and adverse-treatment consequences for the actual marginal mix, including how many patients resemble post-MI trial participants; determine q and unmodeled z.
• Evidence that routine donations expand Fill the Gap or another high-yield cohort rather than merely replacing existing grants or customer receipts; no restricted-program assumption is authorized.