Racial Disparities, Prescription Medications, And Fostering Equity In America

The United States has the highest drug prices in the world, and it’s not even close. For millions in the country, the cost of prescription drugs is an ever-growing barrier to proper disease treatment. This is most often the case for minority groups, who have long experienced disproportionally adverse health access and outcomes. But high drug prices alone do not explain the inequity we see. Minorities Face Many Barriers to Prescription Medicines. Costs: White Americans are, on average, much wealthier than Black and Hispanic Americans. The median net worth of White households in 2016 was 9.7 times higher than African-American households and 8.3 times higher than Hispanic households. Wealth disparities result in negative health consequences. Lack of Insurance: Affording medications is even harder for those without coverage. Though the Affordable Care Act (ACA) reduced the number of uninsured Americans, over 28 million remain without insurance. More than half (55%) of uninsured Americans under the age of 65 are people of color. For those with no insurance, paying retail prices for medications is often financially impossible. Implicit Racial Bias in Prescribing Practice: Race can have an implicit effect on the prescribing practices of providers. For example, one study showed that White children treated at pediatric emergency departments inappropriately received antibiotics for respiratory infections more often than Black or Hispanic children, indicating that prescribing patterns can vary depending on the race of the patient. Practical Cost: White Americans are, on average, much wealthier than Black and Hispanic Americans. The median net worth of White households in 2016 was 9.7 times higher than African-American households and 8.3 times higher than Hispanic households. Wealth disparities result in negative health consequences. Among insured adults with diabetes, (Medication underuse is a somewhat common cost saving strategy, per the CDC.) The authors attribute this to lower incomes and higher out-of-pocket drug costs. Although study participants all had health insurance, disparities persisted. Lack of Insurance: Affording medications is even harder for those without coverage. Though the Affordable Care Act (ACA) reduced the number of uninsured Americans over 28.

Practical Policy Pursuits South Carolina and the ACA’s Medicaid expansion

South Carolina has not expanded Medicaid, and is the first of the non-expansion states to receive federal approval for a Medicaid work requirement

South Carolina’s governor and legislature have strongly rejected Medicaid expansion under the Affordable Care Act (ACA). As a result, there are about 121,000 people in the state who are in the “coverage gap” with no realistic access to health insurance. They are the state’s poorest residents, with incomes under the poverty level. They do not qualify for subsidies in the exchange and they also do not qualify for Medicaid. In many cases, they rely on emergency rooms and community health clinics, but future funding for those clinics is in jeopardy too.

Since 2017, Republican Henry McMaster has been the governor of South Carolina (McMaster was the lieutenant governor and took office as the governor when Nikki Haley was appointed by President Trump to be the U.S. Ambassador to the United Nations). McMaster is opposed to Medicaid expansion, as was Haley.

The ACA has played a key role in increasing health insurance among low-income people of color. Prescription drugs are one of ten essential health benefits the ACA requires insurers to cover. Interventions to increase coverage are needed, particularly in regard to medications. Research shows that promoting coverage gains through increased advertising is effective.

Seventy-three-year-old Leonard L. Edloe, a pharmacist of 50 years and pastor of a predominately Black church in Middlesex County, Va., knows the personal and professional sides of heart disease, stroke, and diabetes well. He also knows the astronomical costs of prescription medications and the related financial struggles. “The pricing has gone through the roof,” he said in an interview. “I mean, insulin – a month’s supply for some people – is $600.” That’s $7,200 a year. “Even the generic pricing has gone up,” he points out. “That has become worse because so many of the drugs are imported. Seventy-five percent of the drugs in the United States have an ingredient that’s made in China, India or Germany.”

Edloe explained that “Because there’s no control over pricing in the United States, they can basically charge what they want to; whereas in other countries, the government decides.”