Report shows higher non-adherence, even after accounting for income, education and insurance coverage
While employers offer benefit plans to boost employee health and retention, they may not realize usage rates vary by race in Canada.
Black adults in Canada are significantly more likely than white adults to skip or delay taking prescribed medication because of cost, finds a study from the Canadian Medical Association Journal (CMAJ).
On average, 12.2% of Black adults experienced cost‑related prescription non-adherence, compared with 5.8% of white adults. The study defined this non-adherence as a person, in the previous year, who did not fill or collect a prescription for medicine, or skipped doses of medicine because of the cost.
The national analysis, published March 23, 2026, examined five cycles of the Canadian Community Health Survey (2015, 2016, 2018, 2019 and 2022) and focused on adults in the 10 provinces who had at least one prescription in the previous 12 months.
Risk remains after adjusting for income and education
The disparity stands even after accounting for income, education and insurance coverage, according to the research.
Using multivariable Poisson regression, the research team found that Black adults had more than twice the prevalence of cost‑related non-adherence compared with white adults (unadjusted prevalence ratio 2.11). After adjusting for age, sex and other non‑modifiable demographic factors, the prevalence among Black adults “remained 75% higher than among white adults (adjusted PR 1.75, 95% CI 1.43 to 2.14),” the CMAJ reported.
When the model further controlled for marital status, education, employment, personal and household income, chronic conditions, self‑perceived health, mental health, life satisfaction and prescription insurance, Black racial or cultural background was still independently associated with cost‑related non-adherence. In the fully adjusted model, the prevalence ratio for Black adults was 1.36 (95% CI 1.13 to 1.64), leading the authors to conclude that “racial disparities in cost-related prescription non-adherence could not be fully explained” by the measured socioeconomic and health factors.
For HR professionals, that means seemingly neutral benefit designs can still produce unequal outcomes, especially for Black employees and their families.
Drug coverage in Canada
The CMAJ study also documented consistent disparities in prescription drug coverage. Among Black adults, coverage for all or part of prescription medication costs was 71.6% in 2015 and 72.5% in 2022. Among white adults, coverage was 83.0% in 2015 and 80.0% in 2022.
Having any prescription coverage sharply reduced the likelihood of skipping or rationing medicine. In the fully adjusted model, “prescription medication coverage was associated with a lower likelihood of cost-related prescription non-adherence (adjusted PR 0.44, 95% CI 0.41 to 0.46).”
The article places the findings in a broader policy context, noting that Canada is the only high-income country with a public health insurance program that does not provide universal coverage for prescription medications. Instead, coverage comes from a mix of provincial programs, employer‑sponsored plans and private insurance, creating uneven out‑of‑pocket costs.
Because private drug coverage is closely tied to employment status and income, HR decisions about eligibility rules, waiting periods and plan design can directly influence whether Black workers face higher health risks from unaffordable prescriptions, says the report.
Pharmacare benefits
The CMAJ notes that the federal Pharmacare Act (C‑64), which offers publicly funded, single‑payer, first‑dollar coverage for some diabetes drugs, received Royal Assent on Oct. 10, 2024 and is in the early stages of implementation.
“Everyone in Canada deserves access to the care they need, including to prescription medications,” said Mark Holland, then minister of health. “Our plan for universal access to contraception means reproductive freedom and choice and access to diabetes medication is a transformational step towards improving health outcomes and health equity in Canada. I thank all partners for their contributions to making this happen.”
The CMAJ report authors say more research is needed “to assess the effect of this legislation and public prescription medication coverage on cost-related prescription nonadherence in Black populations.”
“Even though many Canadians have some form of coverage, Canada relies on a confusing patchwork of over 100 public prescription drug plans and over 100,000 private plans—with a variety of premiums, copayments, deductibles and annual limits. For a family or a single patient with a complex condition, those costs can add up to a significant barrier,” noted Dr. Eric Hoskins, chair of the Advisory Council on the Implementation of National Pharmacare, in the 2019 report A Prescription for Canada: Achieving Pharmacare for All.
