Affordability in Canada is a growing problem, with high costs of food, shelter, medications, and more forcing Canadians to prioritize where to spend. New research found that rates of cost-related prescription nonadherence, defined as not filling prescriptions, delaying filling prescriptions, or splitting or skipping doses due to financial constraints, were higher among Black adults than White adults. The study was published in CMAJ (Canadian Medical Association Journal).
To understand the association between Black racial identity and cost-related prescription nonadherence, researchers studied data from the Canadian Community Health Survey, representing 10 Canadian provinces in 2015, 2016, 2018, 2019, and 2022. The analysis included 181 511 adults aged 18 and older, with 2997 Black and 178 514 White participants. The researchers found that the rates of cost-related prescription nonadherence in Black adults ranged from 15% in 2015 to 10% in 2022, compared with about 6% in White adults over the same time frame. As well, fewer Black adults than White adults had insurance coverage for prescription medications (72% v. 80% to 83%).
“We found a significantly higher annual prevalence of cost-related prescription nonadherence among Black adults who reported having a prescription in the last year in Canada, compared with White adults,” writes Dr. Oluwabukola Salami, professor in the Department of Community Health Sciences at the Cumming School of Medicine and the Faculty of Nursing, University of Calgary, Calgary, Alberta, with coauthors.
Research in the United States has found similar trends in Black Americans.
“Although factors such as education, income, chronic conditions, health perceptions, and insurance coverage partially mediated this association, Black racial or cultural background remained independently associated with a higher prevalence of cost-related prescription nonadherence,” write the authors. “Furthermore, having insurance coverage significantly reduced the prevalence of cost-related prescription nonadherence among both Black and White adults.”
The authors call for more research to understand the reasons for these discrepancies in prescription adherence and to understand the effect of recently introduced national pharmacare coverage. The authors also call for equity-focused pharmacare coverage.
Another article published in the same issue of CMAJ provides a snapshot for clinicians on how to support families facing financial challenges.
“Disparities in cost-related prescription nonadherence between Black and White adults in Canada” and “Low-income families” are published March 23, 2026.