When Deana Youngblood returned from a trip to South Carolina in 2025, she was coughing up something dark and struggling to breathe. She had no health insurance and nowhere obvious to turn, so she called Wheeling Health Right, the only free clinic in West Virginia’s Northern Panhandle.

By the next day, Youngblood had received a chest X-ray, an antibiotic and a donated inhaler to manage her COPD, treatment she otherwise could not afford.

“What would be my workaround without Health Right?” Youngblood said. “I honestly don’t know.”

The inhaler Youngblood received was donated by Direct Relief through a partnership with Teva. Since 2008, Direct Relief has made 251,471 deliveries of donated medicines and medical supplies, with a cumulative wholesale value of $3.1 billion, to nonprofit health providers in all 50 states and multiple U.S. territories.

More than $1 billion of that aid has been delivered since June 2023. The total represents the cumulative wholesale value assigned to the donated products, not the amount Direct Relief paid for them or what patients would otherwise have spent.

The acceleration reflects both expanded capacity and rising need. Nearly six in 10 U.S. adults worry about affording prescription drugs, the highest share KFF has recorded since it began asking in 2018. More than four in 10 report taking at least one cost-saving measure that altered their treatment.

That affordability pressure is reaching the safety-net clinics that patients without other options rely on. At Mosaic Health Center in Georgia, a charitable clinic serving only uninsured patients, calls for new-patient appointments rose through the final months of 2025 after marketplace shoppers found higher premiums, enough that the clinic extended its evening hours.

Dallas Smith, a volunteer pharmacist there for five years, said the gap often isn’t the expensive drugs. “Medications like metformin and amlodipine and some of your basic hypertension or diabetes medications, they aren’t the most expensive, but patients who don’t have a lot of room to work with in terms of their budget, that adds up,” he said. “Even if it’s only $30 to $40 a month, that could be spent on food for their kids.”

What’s in the $3 Billion

The $3 billion total is the result of a nationwide distribution system built to move charitable medicine at scale. Because Direct Relief holds wholesale distribution licenses in all 50 states, the products move through the same regulated supply chain as commercially sold medicines, with pharmacist review and temperature controls throughout.

Teva Pharmaceuticals is providing inhalers for uninsured patients with asthma and COPD through a program launched with Direct Relief in December 2024. Medicines360 and Bayer have supported access to long-acting contraception for uninsured women, helping provide products that are otherwise among the most expensive contraceptive options to obtain out of pocket.

Donations often work in combination. Eli Lilly donates insulin for distribution to community health centers serving patients with diabetes, while  embecta contributes millions of pen needles and insulin syringes needed to administer much of that insulin.

Through Direct Relief’s ReplenishRx program, contributions from AbbVie, Alcon, Johnson & Johnson, Sanofi and others provide uninsured patients with consistent monthly access to prescription medicines needed to manage chronic diseases.

Since 2017, Direct Relief has distributed more than 3.5 million doses of naloxone through partnerships with Pfizer, while BD has donated needles and syringes that go out with them.

Much of Direct Relief’s U.S. aid is transported with in-kind logistics support from FedEx, helping medicines and supplies reach nonprofit health providers across the country.

Together, those partnerships turn donated products, funding, logistics and technical expertise into a national supply network. More than 175 companies across health care, technology, transportation and other sectors help Direct Relief deliver more than $300 million in medical aid each year to more than 2,000 community-based organizations nationwide.

From a Hurricane to a National Charitable Medicine Program

Before Hurricane Katrina, Direct Relief’s work was concentrated primarily outside the United States. When the storm struck the Gulf Coast in 2005, people with diabetes, heart disease and other chronic conditions lost access to the medicines that kept those conditions in check, and manageable illnesses became emergencies.

Direct Relief delivered more than $50 million in material medical aid and cash assistance within six months, then built the licensing and distribution infrastructure required to distribute prescription medicines nationwide. It has retained and expanded that infrastructure ever since, seeded by investments from medtech company Abbott Laboratories.

Direct Relief’s U.S. aid now fills persistent gaps in medicine access while turning an existing provider network into a lifeline when disasters cut patients off from routine care.

In western North Carolina, Hurricane Helene knocked out the roads, bridges, post offices and cell service that NC MedAssist, a statewide charitable pharmacy, relies on to reach more than 70,000 patients across all 100 counties.

Staff called patients individually to arrange insulin shipments through 80-degree heat, asked helicopter crews headed to rural areas to carry medicine with them, and moved prescriptions on hospital mobile-pharmacy units. Direct Relief sent insulin, tetanus vaccines, field medic packs and epinephrine injectors, the last for an unexpected reason. “With the pure disruption of the ecosystem, there are a lot of bees and yellowjackets,” said Dustin Allen, the pharmacy’s chief operating officer.

More telling was what patients weren’t asking for. Requests for mental health medications, anti-seizure drugs and treatments for hypertension and high cholesterol ran lower than expected. According to Allen, that was a sign that people were cut off from routine care were going without.

In Puerto Rico, Direct Relief spent the years after Hurricane Maria building the infrastructure the storm showed was missing. An estimated 4,600 people died in the storm’s aftermath. In roughly a third of cases, the reason was because they could not reach care in time.

Since 2017, Direct Relief has provided $56.4 million in financial support and $96.7 million in material medical aid across the island, funding 52 resilient-power projects, 67 mobile clinics and off-road vehicles, and wells serving communities without municipal water. The work was supported in large part by AbbVie.

At Profamilias, a San Juan clinic providing reproductive and chronic disease care, generators once ran mainly to keep the pharmacy cold — and during hurricanes, even that failed. “Employees had to take certain products home and keep them refrigerated because there was no way to store them at the facility,” said services manager Michael Domínguez. After Maria, he said, “people had to buy medications wherever they could, at whatever price.”

The resilient power systems have since been tested repeatedly. When Hurricane Fiona struck in September 2022, all nine solar-equipped community health clinics stayed operational and all 25 community wells kept delivering clean water.

What the infrastructure enables now expands beyond storms. In February, Direct Relief joined COSSAO, Ponce Health Sciences University, and RWJ Barnabas Health to provide cardiology, pulmonology, gynecology, and other specialist services to 59 residents of Utuado, many of whom were accessing this level of care for the first time.

The lesson is the same one Katrina taught two decades earlier: resilience depends on building systems before disaster strikes and sustaining them through the next crisis.

Dual Pressures of Coverage and Climate

Coverage pressures are also expected to grow. Federal law requires states to apply Medicaid work requirements to many adults covered through Medicaid expansion beginning Jan. 1, 2027, though states may act sooner.

KFF research has found that eligible people may lose coverage when state systems cannot verify their status or when enrollees are unable to provide the required documentation.

Health center leaders describe the strain directly. “Community health centers are caring for more patients with more complex needs than ever before, even as workforce shortages and financial pressures intensify,” Kyu Rhee, president and CEO of the National Association of Community Health Centers, said in April.

Meanwhile, billion-dollar weather and climate disasters are being recorded far more often. The United States averaged three such disasters a year during the 1980s and 20 annually from 2016 through 2025, according to Climate Central. Twelve occurred during the first half of 2026 alone.

For the health safety net, the pressures compound. A lapsed insurance plan and a washed-out road produce the same result: care that is harder to access.

What Happens Next

Against this backdrop, Direct Relief remains committed to expanding the network of providers it supports and the range of products it provides. The mechanics stay the same: eligible nonprofit providers request what their patients need, Direct Relief delivers at no cost, and no one is billed for a donated item. Not the patient, insurer or a government program.

Donated medicine does not fix insurance gaps or staffing shortages. But for patients like Youngblood, a free prescription can mean the difference between managing a chronic illness and being unable to breathe.