This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.
In one of their first meetings, representatives of the Ann Arbor-based nonprofit
YesRx and the Sault Tribe of Chippewa Indians wasted no time getting started on their plan to expand the tribe's access to cancer medications. YesRx CEO Siobhan Norman says one tribal representative came prepared with a list of tribe members who needed help accessing drugs to fight cancer.
"She said, 'I know I can think of three different patients who could really use help right now,'" Norman says. "And the next day that medication is on its way up to the Sault so that they can provide it to their patients. That's how easy it is."
And that was just the beginning of a partnership that aims to improve cancer drug access and reduce medication waste among the tribe for the long term. Last year YesRx received a $150,000
Michigan Health Endowment Fund Community Health Impact grant to work with the Sault Ste. Marie-based tribe over a two-year period, adding the tribe to its list of over 100 partners across Michigan. YesRx was founded in 2023 to manage cancer drug repositories (CDRs), which collect and redistribute unused cancer medications, throughout the state. Given that Native Americans have the
poorest five-year cancer survival rate of any ethnic or minority group in the U.S., the Sault partnership represents an important first step toward bringing YesRx's services to Michigan's tribal communities.
"We want to learn so much more so that we can make this a stable resource in [the Sault tribe's] community," Norman says.
Beth Sieloff, a public health specialist at the Intertribal Council of Michigan, focuses on cancer prevention and treatment for all 12 federally recognized Native American tribes in Michigan. She says YesRx is bringing a welcome resource to the Sault tribe.
"Instead of those drugs going in the groundwater or the landfills or somebody's back drawer until they expire, YesRx ... can redistribute them to someone who doesn't have the financial means or access to some of these medications," Sieloff says. "You think of a population who were stripped of everything, right? Their land, their culture, their people. And YesRx is a way of ensuring that we're giving back in a way that is going to bring quality of life for the cancer patients and their families."
Origins of Michigan's cancer drug repository system
In 2006, Michigan Public Act No. 416 permitted the creation of a state CDR program that would allow people to donate unused cancer medications to be redistributed to others in need. However, Norman says there was a "gap" of 15 years before health care organizations actually began establishing CDR sites, due to the challenges of implementing the programs. Norman says a pharmacist at MyMichigan Medical Center Midland, Katie Sias, put in the work to launch the state's first CDR site in 2021.
"There's a story she shares, that her oncologist came in her office and put a bottle of medication on her desk and said, 'This is a Honda Civic,'" Norman says, referring to the high cost of cancer drugs, which can go for thousands or tens of thousands of dollars. "And it really made her think, 'Am I gonna throw this away again?'"
Since then, CDR sites have proliferated quickly in Michigan. Fourteen hospital pharmacies across the state now fully participate in the state CDR program, and another 27 participate partially. Norman says YesRx formed in part to solve the problem of donated medications not always matching patient needs, as well as the need for a large space to store donations. The nonprofit established a central repository at the Trinity Health Reichert Medical Center in Superior Township, which collects donations from across the state and then distributes them to participating sites based on patient need.
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YesRxPharmacists handle cancer medications at the cancer drug repository at the Trinity Health Reichert Medical Center in Superior Township.
"We provide the resources, the administrative lift, and we provide the funding that is necessary to move the medications from donation to the pharmacy sites, and then from the pharmacy sites to the clinics, so those clinicians can provide it to their patients absolutely for free," Norman says.
In 2016, an oft-cited
study found that the U.S. wastes $3 billion a year in cancer drugs, a number Norman says is "grossly underestimated." YesRx Chief Medical Officer Dr. Emily Mackler says advances in cancer treatment have made drugs "much more precise" than they were 20 years ago, but also much more expensive. If a doctor changes a cancer patient's medication or dosage, hundreds or thousands of dollars of medication may go unused – or worse, thrown away.
"When medications are wasted and thrown out, they go somewhere, and it's in our land and water," Mackler says. "Medications that end up in our water sources and in our land ultimately are not good, and so we're trying to mitigate that."
Mackler says the challenges that many cancer patients face in trying to obtain medication make many of them eager to pass on their unused drugs.
"It's something that really gives the community power to be able to give back and help others in similar situations that they may have experienced," she says.
Addressing tribal needs
Mackler and Norman say working with tribal communities was a natural next step in YesRx's mission to get cancer drugs to those most in need. Sault tribe members experience many particularly challenging barriers to cancer care. That's why Sieloff immediately asked Mackler to work with the tribe when the two women met a couple of years ago.
"Even for middle-class Americans, cancer care is very expensive," Sieloff says. "But then you put in the rural piece, and then you put in an underserved population. The financial barriers are just compounded over and over again, and the care gets more and more fragmented."
Given the statistics on Native Americans' overall low rate of cancer survivorship, YesRx staff wanted to work with a tribe in the U.P. Mackler says she's worked with several tribal health centers in recent years to better understand their communities' needs.
"Hearing the challenges of individuals who are receiving treatment for their cancer really was compelling for us to be able to ensure that we reach that population and community, and ensure that they receive the same resources that the rest of the state does, if not more," she says.
Although Norman notes that YesRx staff have already been able to "positively impact" Sault tribe patients through the early referrals they received, YesRx's partnership with the Sault tribe is still just getting started. This summer, YesRx will partner with the
Inter-Tribal Council of Michigan to host events that will invite tribe members to share their experiences with cancer treatment and their recommendations for improving medication distribution.
One unique challenge, already under examination by YesRx staff, is the disconnect between tribal health clinics and specialty care providers like oncology centers. Upper Peninsula residents in general have
limited access to hospitals, compared to the rest of Michigan. Sieloff notes that the closest cancer care centers to the Sault tribe are in Petoskey, Traverse City, and Ann Arbor – respectively a 105-minute, 3-hour, or nearly 5-hour drive from tribe headquarters in Sault Ste. Marie. She says that gives tribe members a profound sense of disconnection from their local providers at tribal clinics. Mackler says YesRx hopes to "bridge" that gap.
"With YesRX, now we're eliminating some of these barriers," Sieloff says. "The financial barriers are being reduced. The medications are being distributed by a pharmacist [that patients] know and trust, because there is a pharmacist within the Sault tribe health system that is gonna give them their cancer medication. So it's eliminating financial barriers, but it's also giving the local health system more insight into the care that the patient's receiving through their oncologist."
Mackler emphasizes that both medication distribution and waste prevention are "big priorities" of the partnership. She hopes that the grant will help YesRx to better quantify the environmental impact of medication waste as it works to reclaim unused meds in the Sault tribal community. She says YesRx staff are conscious of how important natural resource preservation is to the tribe.
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Matt LamphereLake Michigan in the eastern Upper Peninsula.
"We want to make sure we're doing our part in preserving that component as well," Mackler says. "And so the offering of donations, and being able to accept them and allow them to be repurposed to those who need them, is equally important to us."
Sieloff says she's been impressed by Mackler and Norman's "compassion" and cultural sensitivity in bringing their work to the Sault tribe.
"When we serve our underserved populations, regardless of race, we need to ... not just apply our programs to them, but walk with them and see how we can adapt the program," she says. "And that's what Emily and Siobhan understand, is that it's walking with folks. That really can heal and advance equitable care."
Next steps
Norman says the main focus of YesRx's grant proposal to the Michigan Health Endowment Fund was that YesRx's work "would have a longstanding impact" in the Sault tribe community.
"We would be learning and then bringing those learnings back to the community so that they could ... always have this as a resource that's available for their patients in their community," she says. "So we'll be equipping them with tools and access so that it could be used for as long as they want."
Norman adds that YesRx staff hope to take learnings from the Sault tribe partnership into future work with other Michigan tribes. The nonprofit recently received funding from the Michigan Department of Environment, Great Lakes, and Energy to begin similar work with the Little Traverse Bay Bands of Odawa Indians.
"Ideally we would love to be able to offer this to all the tribes in Michigan," Norman says.
Sieloff says she thinks maintaining the initiative for the long run among the Sault tribe, and duplicating it in other tribal communities, is "doable."
"It will be very accessible to replicate, but it all depends on the generosity of family members who have lost a loved one to cancer, or individuals on a cancer journey who realize that their unused medications can go to help someone else," she says. "It can be done."