Racial and ethnic disparities in prescription coverage and medication use

Health Care Financing Review, Winter, 2003 by Becky Briesacher, Rhona Limcangco, Darrell Gaskin

Table 1
Select Characteristics of Medicare Beneficiaries, by Chronic
Conditions: 1999

                                          Heart
Characteristic      All     Diabetes   Disease (1)   Hypertension (2)

Total
  (in Millions)    30.656    4.916       13.485           7.052

Percent by Race/Ethnicity

White               85.6      78.0        87.1             82.7
Black               7.6       12.0         7.0             9.5
Hispanic            6.7       10.0         5.9             7.8

Age

65-69 Years         25.0      22.8        20.3             22.8
70-74 Years         26.5      30.6        24.5             26.3
75-79 Years         22.8      24.0        25.2             24.4
80 Years or Over    25.6      22.6        30.0             26.5

Sex

Female              57.8      53.9        54.8             63.5

Income as Percent of FPL

[less than or
  equal to] 100     20.4      24.9        21.1             19.6
100-200             31.5      34.1        33.4             31.3
>200                48.1      41.0        45.5             49.1

Self-Reported Health Status

Poor                6.7       10.3         8.7             3.0
Fair                16.9      23.9        22.0             13.0
Good/Excellent      78.2      65.8        69.3             84.0

Burden of Chronic Conditions (3)

1                   16.4      3.3          4.3             18.1
2                   23.8      12.2        16.3             42.0
3 or More           51.2      84.5        79.4             39.9

(1) Includes individuals reporting they have been told they have
angina/coronary heart disease, myocardial infarction, atherosclerosis,
or other heart disease.

(2) Includes individuals reporting they have been told that they have
hypertension. It excludes hypertensive individuals with diabetes and/
or heart disease.

(3) Chronic conditions include self-reported conditions of
hypertension, stroke, heart disease (anginalcoronary heart disease,
myocardial infarction, atherosclerosis, other heart disease), diabetes,
arthritis (osteoarthhtis, rheumatoid arthritis), Alzheimer's disease,
osteoporosis, mental disorder, lung disorder (emphysema, chronic
obstructive pulmonary disease, asthma), and cancer.

NOTE: Excludes beneficiaries with end stage renal disease entitlement.

SOURCE: Centers for Medicare & Medicaid Services: Data from the
Medicare Current Beneficiary Survey Cost and Use File, 1999.

Table 2
Prescription Drug Coverage of Medicare Beneficiaries with Chronic
Conditions (1), by Race/Ethnicity: 1999

                            Beneficiaries

Coverage (2)         White     Black      Hispanic

                              Percent

M C                  17.7     ** 21.1    ** 25.2
Medicaid              5.0     ** 24.9    ** 29.3
Employer Sponsored   38.2     ** 25.9    ** 12.6
Medigap              15.6      ** 7.3     ** 6.7
Other (3)            12.5     ** 17.0    ** 15.6
No Coverage          23.7     ** 21.3    ** 23.1

** p<0.05 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

(1) Chronic conditions: diabetes, hypertension, or heart disease.

(2) Categories are not mutually exclusive.

(3) Includes other public (such as State-funded prescription assistance
program and Department of Veterans Affairs) and unknown source.

NOTE: n = 22.6 million.

SOURCE: Centers for Medicare & Medicaid Services: Data from the
Medicare Current Beneficiary Survey Cost and Use File, 1999.

Table 3
Prescription Use and Expenditures for Medicare Beneficiaries with
Diabetic Conditions (1), by Drug Coverage and Race/Ethnicity: 1999

                                                  Beneficiaries

Coverage (2)                              White       Black    Hispanic

Total (in Millions)                        3.84         0.6        0.47

No Coverage
Average Annual Drug Use                   31.2         25.2       25.2
Average Unit Price                       $37.50     * $28.40     $31.70
Average Out-of-Pocket Cost            $1,095.40   ** $670.5     $889.53
Percent Out-of-Pocket to Total Cost       97.8         93.7      100.0
Percent Prevalence of Any Diabetic        69.9      ** 45.0    ** 52.3
  Drug Use (2)

Medicaid
Average Annual Drug Use                   51.6         39.6       36.6
Average Unit Price                       $32.00       $35.10     $33.50
Average Out-of-Pocket Cost              $334.80    * $182.50    $181.90
Percent Out-of-Pocket to Total Cost       27.9         19.2       18.2
Percent Prevalence of Any Diabetic        71.20     ** 49.5    ** 73.2
  Drug Use (2)

Employer Sponsored
Average Annual Drug Use                   34.8       * 28.8     * 26.4
Average Unit Price                       $56.40       $53.30     $71.83
Average Out-of-Pocket Cost              $463.40      $411.80    $363.93
Percent Out-of-Pocket to Total Cost       29.4       * 35.3       26.23
Percent Prevalence of Any Diabetic        68.8      ** 54.9       51.83
  Drug Use (2)

M C
Average Annual Drug Use                   32.4         30.0       33.6
Average Unit Price                       $31.70       $28.40   * $38.50
Average Out-of-Pocket Cost              $464.40      $456.50    $353.30
Percent Out-of-Pocket to Total Cost       53.0         51.5       42.2
Percent Prevalence of Any Diabetic        73.6      ** 55.5    ** 60.5
  Drug Use (2)

** p<0.05 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

* p<0.10 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

(1) Includes individuals reporting they have been told that they have
diabetes.

(2) Includes hormone such as insulin and oral hypoglycemic drugs.

NOTES: n = 4.9 million. Unweighted n = 1,196 white; n = 218 black;
n = 154 Hispanic.

SOURCE: Centers for Medicare & Medicaid Services: Data from the
Medicare Current Beneficiary Survey Cost and Use File, 1999.

Table 4
Prescription Use and Expenditures for Medicare Beneficiaries with
Heart Disease (1), by Race/Ethnicity: 1999

                                                Beneficiaries

Coverage (2)                           White      Black       Hispanic

Total (in Millions)                     11.75         0.95         0.80

No Coverage
Average Annual Drug Use                 27.6         24.0      ** 20.4
Average Unit Price                     $36.70       $31.10    ** $46.8
Average Out-of-Pocket Cost            $944.60   ** $677.7       $752.60
Percent Out-of-Pocket to Total Cost     93.6         93.1        100.0
Percent Prevalence of Any Heart         76.7      ** 79.4      ** 67.2
  Disease Drug Use (2)

Medicaid
Average Annual Drug Use                 44.4         39.6       * 38.4
Average Unit Price                     $36.20       $31.80       $34.40
Average Out-of-Pocket Cost            $324.10   ** $168.6    ** $200.2
Percent Out-of-Pocket to Total Cost     27.8      ** 19.9      ** 15.5
Percent Prevalence of Any Heart         85.1      ** 87.8      ** 89.1
  Disease Drug Use (2)

Employer Sponsored
Average Annual Drug Use                 31.2         27.6         27.6
Average Unit Price                     $55.30     * $46.5     ** $41.2
Average Out-of-Pocket Cost            $422.00      $347.50      $307.60
Percent Out-of-Pocket to Total Cost     31.6         34.1         32.9
Percent Prevalence of Any Heart         81.7      ** 84.2      ** 85.5
  Disease Drug Use (2)

M C
Average Annual Drug Use                 29.3        30.0          29.3
Average Unit Price                     $33.40      $32.20        $32.4
Average Out-of-Pocket Cost            $386.20     $409.10       $308.70
Percent Out-of-Pocket to Total Cost     50.3        48.3          44.6
Percent Prevalence of Any Heart         77.9     ** 88.6       ** 78.2
  Disease Drug Use (2)

** p<0.05 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

* p<0.10 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

(1) Includes individuals reporting they have been told that they
have hypertension. It excludes hypertensive individuals with diabetes
and/or heart disease.

(2) Includes cardiac drugs, cardiovascular drugs, and diuretics.

NOTES: n = 13.5 million. Unweighted n = 3760 white; n = 334 black;
n = 261 Hispanic.

SOURCE: Centers for Medicare & Medicaid Services: Data from the
Medicare Current Beneficiary Survey Cost and Use File, 1999.

Table 5
Prescription Use and Expenditures for Medicare Beneficiaries with
Hypertension (1), by Race/Ethnicity: 1999

                                                Beneficiaries

Coverage (2)                           White      Black     Hispanic

                                      "3.30   * $000.00   ** $80.10

Total (in Millions)                      5.83        0.66        0.54

No Coverage
Average Annual Drug Use                 16.8        $14.4       12.0
Average Unit Price                     $39.30    *  $33.20    * $31.4
Average Out-of-Pocket Cost            $659.00      $486.30     $526.10
Percent Out-of-Pocket to Total Cost     98.2         99.5       100.0
Percent Prevalence of Any               75.1      ** 71.6     ** 58.8
  Hypertensive Drug Use (2)

Medicaid
Average Annual Drug Use                 31.2     *** 21.6     ** 21.6
Average Unit Price                     $31.40       $34.20   ** $39.6
Average Out-of-Pocket Cost            $190.10      $110.30   ** $80.4
Percent Out-of-Pocket to Total Cost     22.3         18.1      * 13.0
Percent Prevalence of Any               78.8      ** 67.2     ** 73.8
  Hypertensive Drug Use (2)

Employer Sponsored
Average Annual Drug Use                 21.6         14.1        25.2
Average Unit Price                     $55.40       $47.10      $46.80
Average Out-of-Pocket Cost            $326.80      $261.00     $457.40
Percent Out-of-Pocket to Total Cost     33.6         32.7        36.4
Percent Prevalence of Any               76.6      ** 80.8     ** 75.3
  Hypertensive Drug Use (2)

 M C
Average Annual Drug Use                21.6      * 16.8       19.2
Average Unit Price                    $32.70     $30.70      $35.90
Average Out-of-Pocket Cost            $294.00    $201.50     $222.30
Percent Out-of-Pocket to Total Cost    51.2       47.3       * 42.6
Percent Prevalence of Any              69.7      ** 73.7     ** 58.4
  Hypertensive Drug Use (2)

* p<0.05 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

** p<0.10 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

(1) Includes individuals reporting they have been told that they have
hypertension.

(2) Includes hormones such as insulin and oral hypoglycemic drugs.

NOTES: n = 7.0 million. Unweighted n = 1762 white; n = 235 black;
n = 160 Hispanic.

SOURCE: Centers for Medicare & Medicaid Services: Data from the
Medicare Current Beneficiary Survey Cost and Use File, 1999.

Table 6
Adjusted Prescription Use and Out-of-Pocket Spending,
by Drug Coverage and Race/Ethnicity: 1999

                                                  Beneficiaries

                                                      Black

                                               No
Chronic Condition and Drug Use              Coverage      Medicaid

Diabetes
Percent Difference in Use                     * -38        ** -31
Percent Difference in Total Cost             ** -59           -31
Percent Difference in Out-of-Pocket Cost     ** -66            33
Probability of Filling Any Anti-Diabetic   ** OR: 0.39   ** OR: 0.36
  Drug (1)

Heart Disease
Percent Difference in Use                       -13           -14
Percent Difference in Total Cost                -20           -22
Percent Difference in Out-of-Pocket Cost      * -29            19
Probability of Filling Any Anti-Diabetic    OR: 1.41      OR: 1.49
  Drug (1)

Hypertension
Percent Difference in Use                        -1        ** -52
Percent Difference in Total Cost                -11        ** -51
Percent Difference in Out-of-Pocket Cost         -2           -59
Probability of Filling Any Anti-Diabetic    OR: 1.20      OR: 0.66
  Drug (1)

                                                   Hispanic

                                               No
Chronic Condition and Drug Use              Coverage      Medicaid

Diabetes
Percent Difference in Use                       -20        ** -37
Percent Difference in Total Cost                -33        ** -41
Percent Difference in Out-of-Pocket Cost        -30       ** -250
Probability of Filling Any Anti-Diabetic    OR: 0.57      OR: 0.92
  Drug (1)

Heart Disease
Percent Difference in Use                     ** 41           -17
Percent Difference in Total Cost              * -40           -16
Percent Difference in Out-of-Pocket Cost      * -37       ** -277
Probability of Filling Any Anti-Diabetic    OR: 0.61      OR: 1.39
  Drug (1)

Hypertension
Percent Difference in Use                    ** -41         * -27
Percent Difference in Total Cost             ** -59             5
Percent Difference in Out-of-Pocket Cost     ** -50       ** -303
Probability of Filling Any Anti-Diabetic    OR: 0.88      OR: 0.81
  Drug (1)

                                                Beneficiaries


                                                    Black

                                            Employer
Chronic Condition and Drug Use              Sponsored       M C

Diabetes
Percent Difference in Use                       -11           -12
Percent Difference in Total Cost                -14            -2
Percent Difference in Out-of-Pocket Cost         -3           -21
Probability of Filling Any Anti-Diabetic   ** OR: 0.46   ** OR: 0.40
  Drug (1)

Heart Disease
Percent Difference in Use                        -9            -7
Percent Difference in Total Cost              * -25            -8
Percent Difference in Out-of-Pocket Cost        -19           -15
Probability of Filling Any Anti-Diabetic    OR: 1.03     ** OR: 2.92
  Drug (1)

                                             ** -31        ** -31
Hypertension
Percent Difference in Use                         8            -8
Percent Difference in Total Cost                -11           -10
Percent Difference in Out-of-Pocket Cost         -7           -19
Probability of Filling Any Anti-Diabetic    OR: 1.72      OR: 2.33
  Drug (1)

                                                   Hispanic

                                            Employer
Chronic Condition and Drug Use              Sponsored       M C

Diabetes
Percent Difference in Use                    ** -37             6
Percent Difference in Total Cost                -19            25
Percent Difference in Out-of-Pocket Cost        -25           -13
Probability of Filling Any Anti-Diabetic    OR: 0.41     ** OR: 0.36
  Drug (1)

Heart Disease
Percent Difference in Use                       -17           -15
Percent Difference in Total Cost             ** -41           -12
Percent Difference in Out-of-Pocket Cost     ** -30        ** -32
Probability of Filling Any Anti-Diabetic    OR: 1.03      OR: 1.02
  Drug (1)

Hypertension
Percent Difference in Use                        14            -5
Percent Difference in Total Cost                  7             8
Percent Difference in Out-of-Pocket Cost         14           -21
Probability of Filling Any Anti-Diabetic    OR: 1.39      OR: 0.91
  Drug (1)

* p<0.10 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

** p<0.05 black non-Hispanics compared with white non-Hispanics and
Hispanics compared with white non-Hispanics.

(1) Includes hormones such as insulin and oral hypoglycemic drugs.

(2) Includes cardiac drugs, cardiovascular drugs, and diuretics.

NOTES: n = 22.6 million. Adjusted for age, sex, income, self-reported
health status, and number of comforbidities.

SOURCE: Centers for Medicare & Medicaid Services: Data from the
Medicare Current Beneficiary Survey Cost and Use File, 1999.