Rx gap hits Blacks, Latinos

Working-age African Americans and Latinos are much more likely than white Americans to report they cannot afford all of their prescription drugs, according to a new study by the Center for Studying Health System Change (HSC).

Overall, about 20 percent of Blacks, 16 percent of Latinos and 11 percent of non-Hispanic whites did not fill at least one prescription in 2001 because of cost concerns.



Large gap for minorities with chronic conditions

Chronic conditions contribute substantially to racial and ethnic disparities in health status in the United States, particularly for African Americans, and are among the principal reasons why Blacks die at younger ages and at a much higher rate than white Americans. Black Americans also are more likely to have multiple chronic conditions.

Working-age African Americans and Latinos with chronic conditions were substantially more likely than whites to report not having filled at least one prescription in 2001 because of cost. More than 30 percent of Blacks and a quarter of Latinos with chronic conditions didn’t purchase all of their prescriptions in 2001 because of cost, compared with 17 percent of whites living with chronic conditions.

Prescription drugs are critical to ongoing treatment of many chronic conditions, and lack of access to appropriate prescription medication can result in pain, worsening of the condition and increased risk for other related health problems.



Gaps exist among insured but not uninsured

Uninsured people were more than three times as likely as those with private health coverage to have gone without at least one prescription in 2001 because of cost concerns. However, previous HSC research shows that drug-affordability problems are not limited to the uninsured – about a quarter of working-age people with Medicaid or other state coverage did not purchase at least one prescription in 2001 because they could not afford it.

African Americans and Latinos are more likely to be uninsured or to receive their health insurance through a public program, and, as a result, members of these minority groups are more likely to have problems affording all of their prescriptions.

Uninsured African Americans, whites and Latinos were equally likely to report problems affording prescription drugs. All three groups had extremely high rates of affordability problems, particularly among those with chronic conditions. Regardless of race or ethnicity, about 50 percent of working-age uninsured people with chronic conditions reported cost-related prescription drug access problems.



More disparities?

As private and public payers grapple with rising health care costs, including those related to drug price and volume increases, consumers are being asked to pay more for their prescription drugs in a variety of ways. Some have higher co-payments, and most plans now include tiered co-payments where patients pay more for brand name drugs and those not on a preferred list. Others have prescription drug coverage with coinsurance, where patients pay a percentage of the total drug cost rather than a fixed co-payment. Price sensitivity to prescription purchases is strong, particularly among low-income people, meaning that even minimal patient out-of-pocket costs can result in people failing to fill their prescriptions.

African Americans and Latinos are much more likely to have lower incomes than are whites, putting them at greater risk for increased problems paying for their drugs as out-of-pocket costs escalate. And since African Americans and Latinos with chronic health conditions are much more likely than whites to have problems affording all of their prescription drugs already, prescription drug access disparities among those with chronic conditions are likely to increase as patient cost sharing increases. Rising out-of-pocket prescription drug costs may undercut efforts to reduce racial and ethnic disparities in access to health care, including prescription drugs, with the greatest effect on reduced access for minorities with chronic conditions.

Excerpted with permission from Issue Brief No. 73, Center for Studying Health System Change, www.hschange.com.