Most patients encounter insurance delays or denials for prescription medication at some point in their lives. But do certain groups of patients encounter these barriers more often than others? And at what cost?
To explore this question, the Institute for Patient Access analyzed 2019, 2020, and 2021 national pharmacy claims for 3.74 million patients living with one of three diseases: asthma, chronic kidney disease, or cardiovascular disease. Claims data spanned both commercial health plans and Medicare.
The report said in an attempt to lower costs and protect profits, insurance companies can limit access to prescription medication using one of several mechanisms. Prior authorization, for example, can delay patients’ access while the provider waits for health plan approval for the prescribed medication. A lengthy rejection and appeal process sometimes ensues.
Through step therapy, insurers require patients to try and fail one or more medications that the health plan prefers before getting coverage for the prescribed medication. Claims data show that, among asthma, chronic kidney disease, and cardiovascular disease patients covered by commercial insurance, Black and Hispanic patients experience considerably higher rejections than white patients. Not being able to access prescription medications or abandoning prescriptions (because it’s too difficult to get) can contribute to unchecked disease progression and poor health among communities of color.
Some of the key findings
- 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. And Black patients with cardiovascular disease had claims rejected 25% more often than white patients.
Black and Hispanic patients not only experience higher rates of medication rejection, but also experience worse outcomes than white patients later on.
- 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. 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 prescriptions. High out-of-pocket costs can lead patients to leave the pharmacy empty-handed.
White patients have a higher tolerance for high out-of-pocket expenses. Out-of-pocket medication costs averaged $100 or more for Black and Hispanic patients on Medicare.
Regardless of insurance type, Black and Hispanic patients face worse downstream health outcomes than white patients, such as heart disease, stroke, cancer, diabetes, respiratory conditions, obesity, arthritis, and more.
The Institute for Patient Access is a physician-led nonprofit research organization highlighting the benefits of patient-centered care. To see the full report, go to (InstituteForPatientAccess.org).
Black Doctors to Address the Unnecessary Deaths of Black Women in Childbirth
Dr. Linda Burke shares the heartbreaking story on her website – The Smart Mother’s Guide – how Dr. Chaniece Wallace died in 2020 from complications due to childbirth (preeclampsia-related issues). Amber Rose, Kia Dixon Johnson, Sha-Asia Washington and countless other Black women have also died in childbirth.
The unnecessary death of Black women in childbirth is rising. The overall U.S. maternal mortality rate has been increasing, but the data behind the African American community paints an even more devastating picture. Last year, the CDC and an October 2022 GAO report that the Black Maternal Mortality Rate in 2021 was 68.9 deaths per 100,000 (approximately 2,480 women) compared to 26.1 per 100,000 (about 940 women) for white women. Health and Human Services officials and stakeholders said the pandemic worsened factors contributing to maternal health disparities, like access to care.
Additionally, disparities in other adverse outcomes, such as preterm and low birthweight births, persisted for Black or African-American (not Hispanic or Latina) women, according to GAO analysis of CDC data. Black patients often complain that their concerns are not heard nor respected when being seen by a doctor outside of their race, creating a divide between the doctor-patient relationship and ultimately preventing the best possible care.
To affect change, Dr. Linda Burke and an online group of 748+ Black ob-gyn female physicians rallied, but attempts to obtain seats on professional decision-making committees proved futile, leading Dr. Burke to create WHYS (We Hear You, Sister!). WHYS is a resource that would address the challenges patients face in connecting with a doctor they could relate to and bring a more positive outcome to some doctor-patient exchanges.
WHYS is a growing online database and community of 124+ passionate ob-gyn physicians who practice across 29 states in the US, where 88% are board-certified. So far, Texas has about 17 doctors on the list women can contact and none so far from San Antonio.
“Countless Black lives could be saved if women of color knew where to find an ob-gyn that could better understand their challenges,” states Dr. Burke, who has been moved by many stories shared by her colleagues about the uphill battle. “The ability to use my network to build this resource in an attempt to make a difference in the lives of others drives me daily and my greatest hope is that WHYS grows to be a trusted community for all in need.”
WHYS officially launches in February 2023, celebrating Black History Month and Dr. Rebecca Lee Crumpler’s birthday. Dr. Crumpler was the first Black woman to earn a medical degree in the United States. She battled deep-seated prejudice against women and African Americans in medicine. After earning her degree in Boston, she spent time in Richmond, Virginia, after the American Civil War, caring for formerly enslaved people. In 1883, Dr. Crumpler published her Book of Medical Discourses. It chronicles her experiences as a doctor and guides maternal and child health.
To learn more about Dr. Linda Burke and the WHYS movement, visit (TheSmartMothersGuide.com).
Finding Ways to Prioritize Yourself
By Ebony Huerta Wells
Stress, depression, and anxiety, coupled with expectations from family, society, and the fast-paced world we live in, can easily set up a person for a downward spiral.
We see this played out daily in news headlines with high crime rates, suicides, and broken families. This is especially a concern for people of color who already live in a world of systemic racism. Just last year, it was reported that researchers studied nearly 200 Black mothers and found higher rates of postpartum anxiety and depression when linked to the pandemic and racism.
While systemic racism will not be solved overnight, communities of color can find ways to prioritize their happiness and focus on their mental health.
In a recent episode of Oprah Daily’s “The Life You Want,” she interviews therapist and author Dr. Corey Yeager, who counsels players and staff in the NBA’s Detroit Pistons. In his new book, “How Am I Doing,” he asks readers in the opening pages, who is the most important person in your life?
Oprah answered (like many others) everyone else except her. Dr. Yeager said it’s hard to see ourselves as No. 1 when we haven’t been taught how to do it.
“Where does your happiness come from?” said Yeager in his workshop with Oprah. “No one can make us happy. My happiness comes from me. Others can facilitate it, but my happiness is rooted in me. I have to find ways to engage with myself.”
How does Yeager prioritize his happiness? He creates habits by smiling at himself first thing in the morning and lifting his mood by playing Bill Withers “Lovely Day” while getting dressed for work.
Other ways to keep yourself No. 1 are learning to meditate, walk your dog, read a book, exercise, get your hair done, or go on spa appointments. Self-care can cost nothing or something you lavishly give yourself once in a while.
Yeager adds that every day will not be perfect, but the first step is awareness of your actions and feelings and learning to calm yourself down. He often tells basketball players before they take that free throw to put themselves in a calm state of mind where they see themselves positively making that shot. He adds for some people; it’s saying mantras, and for others, it may take something else to create tranquility. The key is creating habits and routines to provide more pleasure, comfort, gratitude, hope, and inspiration, which will lead to positive emotions that increase happiness.
“The Pursuit of Happyness” (the Will Smith movie) doesn’t just have to be about money, but an overall better mental state and happier life. Research proves happy people have better outcomes. According to an article in PositivePsychology.com:
- Happiness is linked to lower heart rate and blood pressure and healthier heart rate variability.
- Happiness can also be a barrier between you and germs – happier people are less likely to get sick.
- More comfortable people release less of the stress hormone cortisol.
- Happy people experience fewer aches and pains, including dizziness, muscle strain, and heartburn.
- Happiness is a protective factor against disease and disability.
- The happiest tend to live significantly longer than those who are not.
- Happiness boosts our immune system, which can help us fight and fend off the common cold.
- Our genetics determines a portion of our happiness (but there’s still plenty of room for attitude adjustments and happiness-boosting exercises!).
- Smelling floral scents like roses can make us happier.
- Those who are paid by the hour may be happier than those on salary (however, these findings are limited, so take them with a grain of salt!).
- Relationships are much more conducive to a happy life than money.
- Happiness can help people cope with arthritis and chronic pain better.
- Being outdoors – especially near the water – can make us happier.
- The holidays can be stressful, even for the happiest among us – an estimated 44% of women and 31% of men get the “holiday blues.”
- Happiness is contagious! When we spend time around happy people, we’re likely to get a boost of happiness.
What is the Difference Between a Cold and Flu?
New York City’s Department of Health has reported an increase in RSV cases each week since mid-September, with a record number of city children hospitalized with the virus in November.
According to the Centers for Disease Control and Prevention (CDC), influenza (flu) and the common cold are both contagious respiratory illnesses, but different viruses cause them. The flu is caused only by influenza, whereas several different viruses, including rhinoviruses, parainfluenza, and seasonal coronaviruses, can cause the common cold. Seasonal coronaviruses should not be confused with SARS-CoV-2, which causes COVID-19.
Because the flu and the common cold have similar symptoms, it can be difficult to tell the difference based on symptoms alone. The flu is generally worse than the common cold; symptoms are typically more intense and begin more abruptly. The flu symptoms can include fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue (tiredness).
Colds are usually milder than flu. People with colds are more likely to have a runny or stuffy nose than those with the flu. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.
Because colds and flu share many symptoms, it can be difficult (or even impossible) to tell the difference between them based on symptoms alone. Special tests can tell if a person is sick with the flu.
Compared to people with the flu, people infected with COVID-19 may take longer to show symptoms and may be contagious for longer periods.
You cannot tell the difference between flu and COVID-19 by the symptoms alone because they have some of the same signs and symptoms. Specific testing is needed to tell what the illness is and to confirm a diagnosis. Having a medical professional administer a specific test that detects both flu and COVID-19 allows you to get diagnosed and treated more quickly for the specific virus you have. Getting treated early for COVID-19 and the flu can reduce your risk of getting very sick. Testing can also reveal if someone has both flu and COVID-19 simultaneously, although this is uncommon. People with the flu and COVID-19 at the same time can have a more severe disease than people with either the flu or COVID-19 alone. Additionally, some people with COVID-19 may also be affected by post-COVID conditions (also known as long COVID).
The CDC recommends that everyone six months and older get the flu vaccine every season. The flu shot does not cause the flu illness. In addition to the flu vaccine for adults, teens, and children, there are flu vaccines approved for different groups:
- Pregnant women
- Older adults (65 years and older)
- Small children
- People with chronic conditions
The flu vaccine is especially important for people with chronic health conditions and those with a high risk of developing complications from the flu. Since infants younger than six months cannot be vaccinated against the flu, it’s crucial that the people around them get the flu shot for the baby’s health.
To find a flu vaccine near you, visit (Vaccines.gov/find-vaccines). Texans can also call 2-1-1 or visit (211Texas.org) to find information on vaccine availability from local public health departments and other nearby nonprofit organizations.
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