Low-income individuals and communities of color in the United States are faced with numerous barriers to accessing health care: limited insurance coverage, poor access to services, lack of education about health topics, and more.
But there is an excruciating pain of a barrier that exists and affects these communities of color: the high cost of prescriptions.
A low-income woman of color suffering from some concerning symptoms barely wades through the American health insurance marketplace nightmare.
She obtains Medicare coverage and finds a physician accepting new Medicare patients. She arranges transportation to her appointment and is diagnosed with a common condition easily managed by a single prescription pill taken daily.
The physician calls in a prescription; the woman arrives at the pharmacy and hands over her Medicare card. The out-of-pocket cost for her medication is hundreds of dollars. The woman is unable to afford the cost and declines the treatment.
This is a scenario that happens daily across America. More than five million Medicare beneficiaries struggle to afford prescription medication. Of those five million people, over three and a half million chose to forgo filling their prescriptions due to cost (Tarazi et al., 2022).
Those who did fill prescriptions still reported behaviors impacting their effectiveness, like rationing, skipping doses, and delaying re-fillings.
This lack of equity created by out-of-pocket prescription costs is infuriating because it falls hardest on those who already face so many other barriers.
People with chronic conditions were the largest group who reported difficulties affording their prescription drugs (Tarazi et al., 2022), resulting in deteriorating conditions and costly acute care episodes (Heath, 2020).
The populations most likely to be impacted by chronic illnesses are people of color. The increased rate of chronic conditions can be traced back to many discriminatory systemic practices.
People of color are also more likely to be uninsured and hit hardest by high prescription drug prices (Attiya and Reck, 2020). What is being done to combat this issue?
Insulin Spending Caps
Insulin continues to be one of the least-affordable prescriptions, despite its absolute necessity for millions living with diabetes.
People of color make up the largest demographic of diabetics in the U.S. (Office of Minority Health, 2018). Eleven states have adopted legislation to impose spending caps on insulin for patients on state-regulated drug plans.
Ending Adverse Tiering
Adverse tiering is a practice within insurance markets of structuring drug formulations to require substantial out-of-pocket cost-sharing for drugs in a particular class, such as expensive-to-treat conditions like HIV/AIDS (Attiya and Reck, 2022).
Some states have introduced legislation that prohibits insurers from placing all drugs in a given class on a specialty tier or prohibits formularies that discourage enrollment by individuals with these health conditions.
Some physicians are working closely with their patients to educate them on their options in prescription costs.
But with only about half of patients reporting their physicians initiated such conversations (Heath, 2020), the burden is falling on the patients to push for transparency.
A push to discuss out-of-pocket costs, generic alternatives, and other forms of treatment before writing prescriptions can go a long way in creating a care plan that a patient can adhere to.
Although some steps have been made in addressing the high cost of prescriptions in the US, there is still more that needs to be done to achieve health equity in the country, especially in communities of color.
Written by: Emmanuel J. Osemota