Drug Coverage Gap Wider For Older Blacks Than Whites

Louanne Bakk, Ph.D. Assistant Professor Director, Institute on Innovative Aging Policy and Practice School of Social Work The University at Buffalo Buffalo, NY 14260

MedicalResearch.com Interview with:
Louanne Bakk, Ph.D
Assistant Professor
Director, Institute on Innovative Aging Policy and Practice
School of Social Work
The University at Buffalo
Buffalo, NY  14260

Medical Research: What is the background for this study? What are the main findings?
Dr. Bakk: Medicare Part D reduces out-of-pocket health care costs and increases access to medications.  While overall the benefit has facilitated the purchase of medications, cost sharing exists and be particularly difficult for more vulnerable populations.  Racial and gender disparities in cost-related nonadherence (CRN)  exist under Medicare Part D plans.  However, it was unknown whether the impact of the coverage gap on older Blacks and females.  This study examined whether the Medicare Part D coverage gap directly and indirectly affects the relationship between race, gender, and CRN.

Racial differences in cost-related nonadherence were largely driven by reaching the coverage gap.  In other words, the gap appears to be more difficult for older Blacks than Whites.  Additionally, both reaching and not reaching the coverage gap, poorer health and having a lower income were associated with cost-related nonadherence .

Medical Research: What should clinicians and patients take away from your report?

Dr. Bakk: While Medicare Part D was enacted to provide financial assistance with medications, clinicians and providers cannot assume that medications are accessible for all of their patients.  Cost sharing still exists, and can be particularly problematic once reaching the coverage gap.  While the Affordable Care Act (ACA) decreases beneficiary cost-sharing once reaching the gap to roughly 47%, this benefit threshold can still be problematic for certain groups.  As a result, they may become nonadherent to a prescribed medication regimen because of  cost.

Clinicians and providers should discuss any cost concerns with patients.  If costs are problematic, resources such as the Low Income Subsidy are available to those that qualify.  Additionally, the Medicare Part D open enrollment period provides beneficiaries with the opportunity to change plans – oftentimes, there is a more affordable option available.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bakk: Future studies should continue to examine the impact of Medicare Part D on cost-related nonadherence among vulnerable populations, particularly as the provisions of the ACA relating to the coverage gap are gradually phased in through 2020.  While the ACA, will gradually reduce cost-sharing in the gap to 25%, annual price increases in brand-name medications, as well as increasing costs associated with Part D plans, can potentially present affordability issues for historically disadvantaged populations.

Additionally, this study only looked at nonadherence due to cost.  Future studies should account for additional factors that can impact adherence.  For examined, the physician trust and communication.


  1. Louanne Bakk. Medicare Part D Coverage Gap: Race, Gender, and Cost-Related Medication Nonadherence. Social Work in Public Health, 2015; 1 DOI: 10.1080/19371918.2015.1052607

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Louanne Bakk, Ph. (2015). Drug Coverage Gap Wider For Older Blacks Than Whites 

Last Updated on August 19, 2015 by Marie Benz MD FAAD