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2006 HSR&D National Meeting Abstract


3029 — Ethnicity and the Impact of Higher Medication Copayments among Veterans with Schizophrenia

Author List:
Zeber JE (VERDICT / UTHSCSA)
Copeland LA (VERDICT / UTHSCSA)
Miller AL (UTHSCSA)
Kilbourne AM (CHERP / Pittsburgh VA)
Velligan D (UTHSCSA)
Mortensen EM (VERDICT / UTHSCSA)

Objectives:
The 2002 Veterans Health Care Act raised medication copayments from $2 to $7 for lower priority patients. Veterans with schizophrenia constitute a multipally disadvantaged population; 40% are antipsychotic non-adherent, substantially increasing psychiatric admission risks. Certain patient sub-groups are particularly sensitive to medication costs. Minority veterans are likely to experience significant ramifications from economic decisions surrounding out-of-pocket pharmacy costs. Diverse cultural expressions of health beliefs and priorities contribute additional layers of complexity. This study examines potential ethnic disparities stemming from higher copayments.

Methods:
All veterans with schizophrenia (FY02) were followed 20 months Pre and Post copayment increase. Longitudinal models observed changes in prescriptions, health services utilization, and pharmacy costs for individuals with copayments versus a control group of exempt patients. Pre-post mean comparisons were conducted among four ethnic groups: white (N=42,853), African-American (N=22,011), Hispanic (N=6,544), and Other (N=9,228). Analyses adjusted for demographics, substance abuse, and other comorbidities.

Results:
African-Americans were relatively younger with significantly higher substance abuse rates; only 37.4% of Hispanics faced copayments versus half of other patients. Minorities used 10-40% fewer VA pharmacy services (fills, costs) than white veterans. Total prescriptions and costs leveled among Copayment veterans following the policy change. Ethnic differences were quite evident in pharmacy patterns and admission risk. White veterans reduced psychotropic fills 12.5% with little change in hospital use. However, minorities substantially dropped psychotropic prescriptions 14.5% – 26.8% while increasing psychiatric admission risks 3.6% – 8.5%; Hispanics ranked highest on both changes. Medical drug fills increased slightly, particularly among minorities, though no outpatient utilization differences were observed.

Implications:
Although all veterans dramatically adjusted pharmacy use following the copayment change, especially psychotropic fills, ethnic minorities appeared particularly sensitive to drug costs and refill decisions for these medications. Similarly, while white veterans appeared to reduce psychotropic use with minimal potential consequences, minorities experienced substantially elevated admission risks associated with lower cost-related adherence. Hispanics were particularly vulnerable to adjusting fill patterns with subsequent clinical ramifications.

Impacts:
Benefit changes for veterans with chronic conditions should be implemented cautiously and carefully evaluated. Reconciling budgetary concerns with quality care provision requires sensitive attention to unique patient groups to ensure equity while minimizing economic and health disparities.


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