Out-of-Pocket Prescription Drug Cost Burden Begets Health Disparities

Out-of-pocket prescription drug costs are a problem for nearly 5 million Medicare beneficiaries, but are especially pressing for Black and Latino people, revealing key racial health disparities in medication affordability, according to Department of Health & Human Services data.

The report, coming out of the Office of the Assistant Secretary for Planning and Evaluation (ASPE), also found low-income people having more trouble with out-of-pocket prescription drug costs.

The high cost of prescription drugs is a well-documented issue in the US. According to the HHS and ASPE researchers, prescription drug costs are nearly double what they are in similarly developed nations, bringing with them key patient financial responsibility and affordability woes.

And when prescription drugs aren’t affordable, medication adherence suffers, the researchers pointed out. High cost is one of the biggest predictors of medication non-adherence, separate studies have shown.

In an assessment of National Health Interview Survey data from 2019, the researchers found not only high prescription drug cost burden for Medicare beneficiaries of all ages, but disproportionate burden experienced by populations of color.

Of the entire Medicare population over age 65, 6.6 percent reported drug affordability challenges, and 2.3 million older Medicare beneficiaries ended up skipping a prescription because of cost. Those figures were 22.7 percent and 1.4 million, respectively, for Medicare beneficiaries under age 65 who qualify for the program due to disability or an end-stage renal disease diagnosis.

Specifically, Black and Latino Medicare beneficiaries over age 65 were 1.5 times as likely to report out-of-pocket prescription drug cost challenges than their White counterparts. They were twice as likely to forego medication access because of high drug costs.

That trend did not emerge for Medicare beneficiaries under age 65. Black and Latino beneficiaries in this age group were less likely than White beneficiaries to skip filling a prescription due to cost. However, American Indian/Alaska Native (AI/AN) people were most likely to skip a prescription due to cost.

Differences also emerged by sex, income level, and disease burden, the researchers said. Across all age groups and races, women with low incomes were more likely to report drug affordability challenges than men and affluent beneficiaries.

What’s more, beneficiaries with chronic conditions were more likely to report affordability challenges and that they forwent prescriptions due to cost. About 10 percent of older beneficiaries and about a quarter of younger beneficiaries with diabetes experienced out-of-pocket cost challenges, for example. This compares to 6.6 percent and 22.7 percent of older and younger patients, respectively, reporting challenges across both age groups.

Those problems were even more pronounced among asthma and COPD patients, the researchers said.

These health disparities in prescription drug cost burden could exacerbate already existing health disparities by race, income, sex, and disease state. As noted above, high prescription drug costs can lead to pill rationing or overall medication non-adherence, which can hamper chronic disease management.

For example, being that Black and Hispanic patients often see a higher rate of many chronic illnesses, including heart disease, these high costs and the risk of medication non-adherence could worsen that problem.

There are some policy moves that could ameliorate these issues, the HHS and ASPE researchers said.

“Potential approaches to improving affordability of prescription drugs in Medicare include direct price negotiations to reduce the cost of expensive medications, limitations on price increases over time, changes to the Medicare Part D benefit to reduce patient cost-sharing and cap beneficiaries’ out-of-pocket spending, and applying Part D pharmacy price concessions at the point of sale,” they concluded the report.

“The findings in this report suggest that such changes would likely improve equitable access to prescription drugs and help improve medication affordability for millions of Medicare beneficiaries.”