Gaps in drug coverage and trust leave more Black plan members without needed medications
Black adults in Canada are skipping or delaying prescriptions for cost reasons at roughly double the rate of white adults — even when they have coverage — according to new research in the Canadian Medical Association Journal.
The CMAJ study used five cycles of the Canadian Community Health Survey (CCHS) to examine cost-related prescription nonadherence among adults who had at least one prescription in the previous year.
Researchers defined nonadherence as not filling or collecting a prescription or skipping doses because of cost.
According to the study, 2997 Black adults and 178,514 white adults formed the final unweighted sample.
After applying Statistics Canada survey weights, an average of 16.54m adults a year were represented, 3.6 percent of whom identified as Black.
The researchers reported that, on average, 12.2 percent of Black adults experienced cost-related prescription nonadherence, compared with 5.8 percent of white adults.
In 2015, prevalence among Black adults reached 15.3 percent and declined to 9.5 percent by 2022, while rates for white adults stayed between 6.0 percent and 5.5 percent over the same period.
In univariable analysis, Black adults had more than twice the prevalence of cost-related prescription nonadherence as white adults, with a prevalence ratio of 2.11.
After the researchers adjusted for nonmodifiable demographic factors such as age, sex at birth, sexual orientation and language spoken at home, cost-related nonadherence among Black adults remained 75 percent higher than among white adults, with an adjusted prevalence ratio of 1.75.
The team then added potential mediators, including marital status, education, employment, family arrangement, income, chronic conditions, self‑perceived health and mental health, life satisfaction and prescription insurance coverage.
Even after that full adjustment, Black racial or cultural background remained associated with a higher prevalence of cost-related nonadherence, with an adjusted prevalence ratio of 1.36.
Coverage helped but did not erase the gap.
As per the CMAJ article, adults with prescription insurance were substantially less likely to report cost-related nonadherence than those without coverage.
The adjusted prevalence ratio for people with prescription medication insurance was 0.44, indicating a strong protective effect.
However, Black adults had lower coverage rates.
According to the study, 71.6 percent of Black adults reported prescription medication coverage in 2015 and 72.5 percent in 2022, compared with 83.0 percent and 80.0 percent among white adults in those years.
When Statistics Canada expanded the questions in 2022 to capture specific cost-related problems, the CMAJ analysis found that Black adults most often reported not filling prescriptions (7.3 percent), delaying fills (6.4 percent) and not collecting prescriptions (3.3 percent).
Among white adults, delaying fills (4.5 percent), not filling prescriptions (3.7 percent) and skipping doses (2.5 percent) were most common.
The prevalence of not filling a prescription was almost double among Black adults compared with white adults.
CTV News reported that senior author Oluwabukola Salami, Canada Research Chair in Black and racialized people’s health at the University of Calgary, said the findings reflect the consequences of socioeconomic inequalities for Black people’s health.
She told CTV that the disparity persisted even after accounting for income and insurance coverage and suggested that unmeasured factors, such as distrust of the health‑care system because of direct or systemic racism, may also play a role.
“This points us to very, very important questions related to the need for equity in medication drug coverage,” Salami said in the CTV interview. “When we think about Canada, we say, you know, we have universal health care — but universal health care that does not include prescriptions.”
CTV News also spoke with Mojola Omole, president of the Black Physicians Association of Ontario, who was not involved in the study.
She said the issue of not being able to afford medication comes up “all the time” in her practice and described cost-related trade‑offs as “a reality for a lot of people” who must choose between prescriptions and basic needs.
