Health Plans Reject Rx Claims More Often for Black, Hispanic Patients

New claims data show that health plans' drug utilization management disproportionately impacts patients of color

WASHINGTON, Dec. 19, 2022 /PRNewswire/ -- Black and Hispanic patients with asthma, cardiovascular disease or chronic kidney disease are more likely than their white peers to have their prescriptions rejected by their health plan, a new data report from the nonprofit Institute for Patient Access explains.

Based on commercial insurance and Medicare claims, the report finds that these patients later experience disproportionately higher rates of emergency room visits and hospitalization. The findings are based on 3.74 million health plan claims made from 2019 through 2021.

READ FULL REPORT

Key Findings

Unequal Medication Access

Across the three disease states, patients of color have coverage for their prescription medication rejected more often than white patients.

• Commercially insured patients. Black and Hispanic patients with chronic kidney disease had claims rejected 40% and 41% more often than white patients did, respectively.
• Medicare beneficiaries. Hispanic patients with cardiovascular disease had claims rejected 40% more often than white patients did. And Black patients with cardiovascular disease had claims rejected 25% more often than white patients did.

Worse Health Outcomes

Black and Hispanic patients not only experience higher rates of medication rejection, but also experience worse outcomes than white patients later on, the report shows.

• Commercially insured patients. For the three disease states examined, Black and Hispanic patients whose medication has been rejected at least twice are more likely to visit the emergency room than are white patients who've had their medication rejected. Black patients with asthma visit emergency rooms 34% more often. Black patients are also more likely than white patients to be hospitalized.
• Medicare patients. Among patients whose medication has been rejected at least twice, Black and Hispanic patients with cardiovascular disease visit the ER 46% and 40% more often than white patients, respectively. They are hospitalized 21% and 15% more often.

The report also finds that Black and Hispanic patients are less able to tolerate high out-of-pocket costs, less likely to use a co-pay card and more likely to abandon their prescription.

STATEMENT FROM MICHELLE WINOKUR, DRPH, EXECUTIVE DIRECTOR, INSTITUTE FOR PATIENT ACCESS:

"The disproportionate rate and impact of utilization management has the potential to perpetuate or even worsen longstanding health disparities. I invite stakeholders to use the findings of this report to work toward equitable access to medications that can have profound impacts on health and quality of life."

The report can be accessed online here.

ABOUT THE INSTITUTE FOR PATIENT ACCESS

The Institute for Patient Access is a physician-led nonprofit 501(c)(3) research organization highlighting the benefits of patient-centered care.

www.instituteforpatientaccess.org

SOURCE Institute for Patient Access

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