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Study Examines Drug, Medicare Racial Gap

WASHINGTON, D.C. July 24, 2003 -- Elderly African-American Medicare beneficiaries are more than twice as likely as whites to report they can't afford prescription medications, according to a national study released today by the Center for Studying Health System Change (HSC).

Almost one in six black Medicare beneficiaries 65 and older did not fill at least one prescription in the last year because of cost, compared with one in 15 whites. African Americans' lower incomes, lack of supplemental insurance and greater prevalence of certain chronic conditions, such as heart disease, high blood pressure and diabetes, all contribute to the prescription drug access gap between older black and white Americans.

"There's no question that the lack of Medicare prescription drug coverage falls disproportionately on African-American seniors," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

"Prescription drugs are an essential aspect of modern medicine, and this study shows many black seniors are going without needed prescription medications," said HSC Health Research Analyst Marie Reed, M.H.S., who co-authored the study with HSC Senior Researcher J. Lee Hargraves, Ph.D.

Both chambers of Congress recently passed legislation to provide prescription drug coverage to Medicare beneficiaries. While details of the House and Senate proposals differ significantly, both provide targeted assistance to some low-income beneficiaries through premium subsidies and reduced cost sharing. Either proposal could help reduce racial disparities in access to prescription drugs among the poorest beneficiaries, but both proposals would leave many low-income beneficiaries-particularly those with incomes above 135 percent of poverty but below 200 percent of poverty-with substantial out-of-pockets costs if they need ongoing or expensive drug therapies.

"As Congress debates how to structure a Medicare drug benefit, this study shows that designing a comprehensive benefit with minimal out-of-pocket costs for all low-income seniors could significantly reduce racial disparities in access to prescription drugs for older Americans," Ginsburg said.

The study's findings are detailed in a new HSC Issue Brief – Unequal Access: African-American Medicare Beneficiaries and the Prescription Drug Gap -- available online at www.hschange.org . Based on results from HSC's Community Tracking Study 2001 Household Survey, a nationally representative survey involving about 60,000 people, the study includes responses from about 7,770 elderly Medicare beneficiaries, excluding those living in institutions such as nursing homes.

Key findings include:
* Nationwide, 7.7 percent of all elderly Medicare beneficiaries, 16.4 percent of black beneficiaries and 6.8 percent of white beneficiaries reported they could not afford to fill at least one prescription in the previous year.

* Poor elderly Medicare beneficiaries-incomes below 100 percent of poverty, or $8,590 for a single person in 2001-are nearly three times as likely as seniors with incomes above 200 percent of poverty to go without a prescription because of cost. Low-income seniors -- between 100 percent and 200 percent of poverty -- are twice as likely as higher income seniors to report they couldn't afford a prescription. Nearly 40 percent of elderly black beneficiaries lived in poverty in 2001, compared with about 10 percent of whites.

* Less than 3 percent of elderly beneficiaries with job-sponsored supplemental insurance said they could not afford at least one prescription, while 14 percent of elderly beneficiaries with only traditional Medicare coverage reported problems affording prescription drugs. Older African-American beneficiaries are much more likely to lack supplemental coverage, with nearly 30 percent of blacks having only traditional Medicare coverage, compared with 10 percent of whites.

* While about 30 percent of both black and white seniors live with one chronic condition, black beneficiaries are more likely to have multiple chronic conditions -- 48 percent of blacks vs. 42 percent of whites. And, older blacks are much more likely to live with heart disease, high blood pressure and diabetes -- 67 percent of blacks vs. 55 percent of whites.

HSC researchers determined that almost half (46%) of the nearly 10-percentage-point gap in prescription drug access between black and white seniors is attributable to differences in income, supplemental insurance coverage and presence of chronic conditions. Another portion of the gap -- nearly 20 percent -- is explained by other factors such as gender, age, family size and education. The remaining access gap likely results from a variety of other influences. For example, people with savings or other assets do not need to rely exclusively on income to afford medications.

Stakeholder Comments on the HSC Study
Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO, The Robert Wood Johnson Foundation said, "Access to health care, including prescription drugs, should be consistent and equitable, regardless of race. This study documents the striking prescription drug access gap between older black and white Americans. As members of Congress tackle the tough job of creating a Medicare drug benefit, they have a unique opportunity to help close the gap and improve the health of older African Americans."

Malcolm Taylor, M.D., president, Association of Black Cardiologists, Inc. said, "While we are concerned that twice as many African Americans cannot always afford to fill their prescriptions, the real crisis is the significant cardiovascular burden for African Americans who are under-diagnosed and under-treated. The fact that only 2 percent of the cardiologists in the United States are African American may also contribute to the health disparities in the United States between whites and minorities. Uncontrolled high blood pressure is the No. 1 health problem in our community with one out of three African Americans affected and only one out of five diagnosed hypertensives adequately treated. Unfortunately, it requires more antihypertensives to lower blood pressure to safe levels for African Americans. The fact that twice as many African Americans have difficulty filling their prescriptions exacerbates the problem leading to too many African-American children growing up without the nurturing guidance of their grandparents."

Source: Center for Studying Health System Change

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