Critics call for universal medication coverage as study finds Black Canadians are less likely to fill prescriptions due to cost

A new Canadian study has uncovered a troubling disparity: Black Canadians are significantly more likely than white Canadians to delay or forgo prescription medications because of cost — a finding that is prompting critics to call on the government to take action.

Canada’s Black population is growing, reaching 1,547,870 back in 2021 and is expected to surpass 3 million by 2041. Data shows that these communities experience higher rates of health disparities, including diabetes, hypertension, and HIV/AIDS mortality. This, coupled with barriers like racism, language barriers, financial constraints, geographic limitations, and mistrust of healthcare providers, has led to hesitancy in seeking and accessing care. 

But a new study has revealed that access to prescription medication is another disparity impacting Black Canadians.

Published in the Canadian Medical Association Journal (CMAJ), the research analyzes data collected from over 180,000 respondents to the Canadian Community Health Survey between 2015 and 2022, including 2,997 Black and 178,514 white adults. The data revealed that cost-related barriers to filling prescriptions remain disproportionately high for Black Canadians.

Among Black adults, about 12.2 per cent reported not filling, delaying or skipping medications due to cost. That’s compared to 5.8 per cent of white adults, a rate of roughly 75 per cent higher.

While the survey data shows that rates of cost-related nonadherence declined over time for white and Black respondents, the disparity between the two communities remained consistent throughout the study period.

Insurance is a factor, but not the only factor

Meanwhile, the study shows Black Canadians were less likely to have prescription drug insurance coverage, a factor strongly associated with better medication adherence. About 72 per cent of Black respondents reported having some form of coverage, compared with about 80 per cent of White adults.

While researchers found that those with private health insurance coverage were much less likely to skip or delay medications due to cost, even after adjusting for insurance and other factors such as income, education, health status and employment, racial disparities in when it came to skipping prescriptions for cost-related reasons remained.

But the findings suggest that financial barriers alone do not fully explain the gap, pointing to broader structural and systemic factors affecting access to medication. Researchers say that Canada’s patchwork approach to prescription drug coverage, with access varying from province to province and often tied to employment or private insurance, could also contribute to inequities in out-of-pocket costs for patients. The study notes that Canada is the only high-income country with a public health insurance program that does not provide universal coverage for prescription medications. 

The authors also point to other potential influences not captured in the data, including patient experiences within the health care system, trust in providers, and barriers such as transportation or pharmacy access. They argue that addressing disparities in prescription drug coverage could be an important step toward improving equitable access to medications, particularly as costs continue to pose challenges for many Canadians.

The study concludes that while expanding insurance coverage is associated with lower rates of cost-related nonadherence, it is not sufficient on its own to eliminate racial disparities in medication access. Authors say more research is needed to better understand the underlying causes of these gaps, and to inform policies aimed at reducing inequities in Canada’s health care system.

Critics call for changes to prescription coverage

Former Toronto-St. Paul’s MPP, Jill Andrew, says provincial officials should be addressing this disparity through universal medication coverage.

“The Ontario government needs to sign a universal Pharmacare agreement to ensure that every Ontarian has universal coverage for prescription medications,” Andrew, who is also a long-time advocate for equitable and healthy communities, told Now Toronto.

“It is not okay that people out here, disproportionately members of our Black community, have to skip doses and split pills in half because they are struggling to make ends meet between the costs of medication, housing, food costs, and tuition,” Andrew continued, adding that some people are skipping their medication altogether due to the out-of-pocket costs.

She shared that the Ontario NDP Official Opposition has long called for universal medication coverage. 

“People should only need their health card – never their credit card for health care, and that must include their prescriptions,” Andrew shared, adding that this is particularly important now, with the province seeing high rates of unemployment and underemployment.

“Many people do not have private health insurance, and their health deteriorates because they cannot afford care. Premier Ford and Health Minister Sylvia Jones must act now,” she continued. “Our people’s lives are depending on it.”

Andrew is also calling on the province to begin collecting race-based healthcare data, something she believes would change the game when it comes to health experiences and outcomes.

“When [the] government doesn’t act, it’s a terrible cycle of indifference that costs lives,” she shared.

Ontario nurse and podcast host Amie Archibald-Varley shared Andrew’s sentiments, adding that she finds the new data less than surprising and something she has seen reflected in her practice. 

“I think this speaks to a greater issue related to health inequities,” Archibald-Varley told Now Toronto, adding that Black communities see many disparities in healthcare, including higher rates of maternal mortality, gynecological conditions like fibroids, and hypertension.

She agrees that prescription medication coverage provided by the government would go a long way to addressing these issues.

“If we’re trying to see healthcare for all people, then that includes Black and other racialized people who are affected by the inequities that we see in healthcare,” she continued.

Like Andrew, she is also calling for the collection of race-based data, which would help to address the disparities impacting racialized communities.

“These are things that we need to address. We can’t just say ‘Here’s the data and here’s the problems,’ we need to come with a solution-focused approach to ensure that we do see the longevity of Black people’s [lives] as well.”

Now Toronto reached out to the Ontario government for comment, but did not hear back in time for publication.