Unequal Access: African-American Medicare Beneficiaries and the Prescription Drug Gap

Unequal Access: African-American Medicare Beneficiaries and the Prescription Drug Gap

Issue Brief No. 64 | July 2003 | By Marie C. Reed, J. Lee Hargraves, and Alwyn Cassil

Older African-American Medicare beneficiaries were more than twice as likely as elderly white beneficiaries to report that they could not afford to fill at least one prescription during the previous year, according to analysis from the Center for Studying Health System Change. The disparity reflected a convergence of factors: elderly Black Americans were substantially more likely to live in poverty, less likely to carry supplemental insurance, and more prone to chronic conditions such as heart disease, high blood pressure and diabetes that require ongoing medication.

Black Seniors Face Greater Barriers to Prescriptions

Prescription drugs formed a critical part of modern medical care, particularly for older Americans. Because Medicare at the time did not cover most outpatient prescriptions, elderly individuals frequently struggled to pay for the medications they needed. Nationally, about one in 12 Medicare beneficiaries aged 65 and older reported being unable to fill at least one prescription due to cost in 2001. For African-American seniors, the figure was nearly one in six, compared with roughly one in 15 for white beneficiaries.

Income as a Driving Factor

Poor elderly Medicare beneficiaries -- those with incomes below 100 percent of the federal poverty level ($8,590 for a single person in 2001) -- were nearly three times as likely as those with incomes above 200 percent of poverty to go without needed prescriptions. Close to 40 percent of elderly Black Medicare beneficiaries lived below the poverty line in 2001, compared with about 10 percent of white beneficiaries. Only around 40 percent of older African Americans had incomes above 200 percent of poverty, versus more than 60 percent of elderly whites. This income gap was a major driver of the prescription access disparity.

The Role of Supplemental Insurance

Supplemental insurance -- which could include some prescription drug coverage -- helped many Medicare beneficiaries manage medication costs. Fewer than 3 percent of elderly beneficiaries with employer-sponsored supplemental coverage reported being unable to afford a needed prescription. By contrast, nearly 14 percent of beneficiaries whose only coverage was traditional fee-for-service Medicare had problems affording medications.

African-American beneficiaries were far less likely to have supplemental coverage of any kind. Nearly 30 percent of older Black Americans in 2001 relied solely on traditional Medicare with no supplement, compared with only 10 percent of whites. Roughly 40 percent of elderly Black Americans carried private supplemental insurance (through former employers or purchased individually), versus 65 percent of white beneficiaries. About 13 percent of elderly Black beneficiaries received supplemental public coverage such as Medicaid, compared with 5 percent of whites.

Chronic Conditions Compound the Problem

Medicare beneficiaries with chronic health conditions were significantly more likely to have trouble paying for prescriptions. Conditions like heart disease, hypertension and diabetes typically require ongoing drug therapy, and failure to take prescribed medications can lead to serious complications. About 48 percent of elderly Black beneficiaries lived with multiple chronic conditions, compared with 42 percent of whites. Black seniors were also more likely to have heart disease, high blood pressure and diabetes specifically -- 67 percent versus 55 percent of whites.

Policy Implications

As policymakers at the time debated how to structure a Medicare prescription drug benefit, the research pointed to the importance of designing a benefit with minimal out-of-pocket costs for low-income elderly Americans. A comprehensive drug benefit with strong affordability protections for those with limited incomes had the potential to substantially narrow the prescription drug access gap between Black and white seniors. The disparities documented in this study underscored how deeply income, insurance status and chronic disease burden intersected to shape medication access among the elderly.

Sources and Further Reading

This analysis was originally published as Issue Brief No. 64 by the Center for Studying Health System Change, using data from the 2001 Community Tracking Study Household Survey. HSC was funded principally by the Robert Wood Johnson Foundation.