((B-307)) (B-307) Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Individuals with Cancer

Background: In the US, medication affordability impacts adherence, with an estimated 30 - 50% of prescriptions not taken as directed, leading to approximately 125,000 preventable deaths each year.

Objectives: To determine cost-related barriers to medication adherence by race and ethnicity in a nationwide cohort of individuals with cancer.

Methods: Study

Design: This cross-sectional study included individuals with cancers projected to have the highest associated costs, enrolled in the NIH All of Us Program—a nationwide longitudinal cohort of U.S. adults with over 630,000 participants. The study focused on individuals diagnosed with tracheal, bronchus, and lung cancer; colon and rectum cancer; liver cancer; breast cancer; and leukemia, identified through EHR diagnosis codes. Data collection occurred from June 2016 to October 2023, with analysis conducted in February 2025.
Exposures: Race and ethnicity defined as Hispanic, non-Hispanic Black, non-Hispanic White and Others.
Main Outcomes and Measures: The primary outcomes of interest in this study were cost-related barriers to medication adherence, including the inability to afford prescription medication, skipping doses to save money, taking lower doses to reduce costs, delaying prescription fills, requesting low-cost alternatives, purchasing medications from another country, and using alternative therapies. Logistic regression was used to assess the association between these barriers and race/ethnicity, adjusting for age, gender, health insurance status, education, and income in multivariable models.

Results: Of 12,583 included individuals, 962 (7.6%) were Hispanic Black, 999 (7.9%) were Others, 972 (7.7%) were Hispanic, and 9,650 (76.6%) were non-Hispanic White. The median (IQR) age was 70 (61-77) years, and 9,819 (78%) were female. After adjusting for confounders Hispanic individuals (odds ratio [OR]: 1.277; 95% Confidence Interval [CI]: 1.001-1.630) and those in the Others group (OR: 1.460; 95% CI: 1.166-1.829) had greater odds of not being able to afford medications as compared to non-Hispanic Whites. All three racial groups, non-Hispanic Black (OR: 0.749; 95% CI: 0.615-0.963), Hispanic (OR: 0.770; 95% CI: 0.615-0.983) and Others (OR: 0.800; 95% CI: 0.656-0.976) were significantly less likely to ask a physician for low-cost alternatives compared to non-Hispanic White individuals.

Conclusions: The study highlights significant racial and ethnic disparities in terms of prescription medication affordability emphasizing the need for improved patient-provider communication, early initiation of discussions about treatment costs and increased awareness about assistance programs and insurance benefit design among cancer survivors.