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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3062 — The Impact of Co-Payment Change on Discontinuation of VA Pharmacy Use

Author List:
Smith BM (MCHSPR and QUERI)
Stroupe K (MCHSPR and Northwestern University)
Lee T (MCHSPR and Northwestern University)
Durazo-Arvizu R (MCHSPR and Northwestern University)
Cao L (MCHSPR)
Nydhham T (MCHSPR)

Objectives:
In February 2002, the co-payment for VA pharmacy medications obtained increased from $2 to $7 for each 30-day supply dispensed. However, the increase was not uniformly applied to all veterans. Depending on a veterans priority class, they may be responsible for co-payments for none (group 1), some (group 2), or all (group 3) of their medications. The objective of this research was to determine the rates of discontinuation of VA pharmacy use after the change, and to examine the association between priority status, patient characteristics, and discontinuation.

Methods:
We acquired data for approximately 5% of male veterans utilizing VA services in the 12 months prior to and following the co-payment increase. Pharmaceutical data was obtained from VA Pharmacy Benefits Management Group; subject characteristics were obtained from VA administrative data. All patients dispensed a prescription for at least one medication in the period before the co-payment change were included in the analysis. Patients that did not fill any medications after the co-payment change were defined as discontinuers. We used logistic regression to examine the association between priority status group and discontinuation of VA pharmacy use.

Results:
There were 125,380 veterans included in the analysis with 16% in group 1, 66% in group 2 and 18% in group 3. The percentage of veterans in group 3 that discontinued using the VA pharmacy after the change (6.52 %) was higher than the percentage in either group 2 (5.37%) or group 1 (4.11%). After controlling for other clinical and demographic characteristics, being a member of group 2 or group 3 was significantly associated with a higher likelihood of discontinuation than group 1.

Implications:
Veterans with a priority status where the medication co-payment was increased were more likely to discontinue their VA pharmacy use after the co-payment change than veterans not required to pay a co-payment.

Impacts:
Veterans affected by the co-payment were more likely to quit using VA pharmacy services after the co-payment change. An important next step is to determine whether or not veterans that discontinued use of VA pharmacy substituted other pharmacy use, and if any decreases in medication use affected health outcomes.


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