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JAMA Internal Medicine: Dual Use of VA and Part D Prescription Drug Benefits Associated with Potentially Unsafe Medication Prescribing to Veterans

March 27, 2020


Takeaway: Veterans receiving prescriptions both inside and outside the VA healthcare system are at increased risk of adverse drug events. Consistent with extensive research findings, VA and the Centers for Medicare and Medicaid Services have formalized an agreement to share near real-time prescription data.

Veterans 65 years and older with prescription drug benefits from VA are almost universally eligible for Medicare Part D. Previous work shows that dual VA-Part D prescription drug use is a risk factor for potentially unsafe medication (PUM) exposure in Veterans with dementia and opioid users. This study evaluated the association of dual prescription use through VA and Part D (vs. VA-only use) with the prevalence of PUM exposure in a national cohort of dually-eligible older Veterans. Findings show:

  • Dual use of VA and Part D prescription drug benefits was associated with an almost 2-fold increase in the odds of exposure to any PUM compared with VA-only use and more than 3 times the odds of exposure to severe drug-drug interactions.

In a JAMA Internal Medicine Invited Commentary by David Shulkin, MD, former VA Secretary, he states that “the MISSION Act will likely dramatically increase the number of Veterans getting at least some of their care from the private sector.” In addition, he states that “An effective integrated system of care for Veterans will require comprehensive care coordination and improved interoperability of data across clinical settings.” Further, through the investigators’ extensive work and consistent findings on the risks of dual VA/Medicare Part D use in dually-eligible Veterans, VA and the Centers for Medicare and Medicaid Services have formalized an agreement to share near real-time prescription data (March 21, 2019).  https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5243

Thorpe J, Thorpe C, Schleiden L, et al. Association between Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits and Potentially Unsafe Prescribing. JAMA Internal Medicine. Research Letter. E-published on July 22, 2019.


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