A UCLA-led study finds that Black and Hispanic Medicare Advantage enrollees with diabetes are less likely to adhere to medication regimens than White patients, with disparities widening in plans with higher Black enrollee shares, highlighting the need for stronger community and insurance support.
A large UCLA Health-led analysis published in JAMA Network Open has found that Black and Hispanic Medicare Advantage enrollees with diabetes were less likely than White patients to take their medicines as prescribed, with the widest gaps appearing in plans that covered a larger share of Black patients. The study, which examined national records from 2019 and included about 587,000 enrollees, found that overall adherence to diabetes medicines stayed below 60%, underscoring how difficult sustained treatment can be even in a population with insurance coverage.
The differences were not uniform across all therapies. Adherence to lower-cost drugs such as metformin remained lower for Black patients in every plan group studied, while the picture for more expensive medicines such as SGLT2 inhibitors and GLP-1 receptor agonists changed with plan composition. In plans with the smallest share of Black members, adherence rates for White and Black beneficiaries were almost identical. In the plans with the largest share of Black enrollees, however, the gap widened sharply. Hispanic enrollees showed a similar pattern, suggesting that coverage alone does not erase broader differences in access and follow-through.
The researchers found that safety-net coverage helped narrow some of the divide. Black and Hispanic beneficiaries were more likely than White beneficiaries to be enrolled in Medicaid or Medicare’s Part D Low-Income Subsidy, and the study estimated that these programmes explained a meaningful share of the difference in adherence, particularly for insulin and newer, higher-cost drugs. By contrast, plan-level features such as star ratings and the type of managed care plan played a smaller role, though they still contributed to disparity. A separate retrospective Medicare analysis published on the JAMA Network Open website came to a similar conclusion, saying that Medicaid and prescription drug subsidies partially eased racial and ethnic gaps in adherence.
The findings sit alongside wider evidence that diabetes burden is unevenly distributed in the United States. A 2024 analysis of National Health and Nutrition Examination Survey data reported higher adjusted diabetes prevalence among non-Hispanic Black adults and Hispanic adults than among non-Hispanic White adults, while the Centres for Disease Control and Prevention says racial and ethnic minority groups and people with lower incomes have long experienced greater diabetes-related illness and death. The UCLA-led authors said the pattern points to a need for stronger insurance and community support, not just broader drug coverage, if adherence is to improve among patients most at risk.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
