Objective: To determine if medication assistance programs (MAPs) provided by pharmaceutical companies were used differently by African Americans and Whites. Research Design: A cross-sectional survey was conducted among patients of primary care practices from 2005 to 2007 within the Alabama Nonsteroidal Anti-Inflammatory Drug (NSAID) Patient Safety Study. Setting: Telephone survey. Participants: Respondents were 568 African American and White patients reporting annual household incomes <$50,000. Main Outcome Measure: Use of MAPs. Results: Of all patients, 12.8% used MAPs, 39.5% were African American, 75.2% were female, 69.1% were aged >65 years, 79.8% had annual household incomes <$25,000, and 35.5% indicated that their income was inadequate to meet their basic needs. MAPs were used by 11.2% African-Americans and 14.0% Whites. After multivariable adjustment, MAP use was higher among respondents with incomes not adequate to meet basic needs (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.17-4.08) but lower among African Americans than Whites (OR: 0.49, 95% CI: 0.25-0.95). Physician characteristics did not independently predict MAP use. Conclusions: Overall MAP use was low even among the most vulnerable, and especially among African Americans. As currently used, MAPs may contribute to disparities in medication access.