2006 HSR&D National Meeting Abstract
1074 — Identifying Primarily Outpatient Pharmacy (POP) Users in the VA: An Update
Hasche JC (Houston Center for Quality of Care and Utilization Studies)
Kuebeler M (Houston Center for Quality of Care and Utilization Studies)
Daw C (Houston Center for Quality of Care and Utilization Studies)
Byrne M (Houston Center for Quality of Care and Utilization Studies)
Petersen LA (Houston Center for Quality of Care and Utilization Studies)
To identify the proportion of patients using the VA health care system primarily for pharmacy services and to examine their impact on costs to the system.
We identified users of the VA health care system in FY2003 and applied a definition for “primarily outpatient pharmacy” (POP) users applied by Zhu et al to a sample of FY1998 patients. POP users are defined as outpatient-only users who meet the following criteria: 1) four or fewer outpatient visits AND; 2) non-pharmacy costs less than $800 AND; 3) pharmacy costs of at least $100 and one-third of annual VA costs. We used the FY03 HERC Person Level Cost file as our source of cost data.
In FY03, 43.1% of VERA funded users had four or fewer outpatient visits, 52.4% had non-pharmacy costs less than $800, and 40.8% had pharmacy costs of at least $100 and greater than 33% of their annual total costs. Taking the intersection of these conditions, we identified 18.9% of all outpatient-only users as POP patients (or 21.6% of all outpatient users with pharmacy costs). POP patients averaged $716 in pharmacy costs and $997 in annual total costs, compared to $821 and $4,039 respectively for non-POP patients. Examining VERA funding categories, we identified 40.8% of POP users as Category C Basics (i.e. non-service connected; not means qualifying), compared to only 17.5% of non-POP users.
In FY03, nearly one in five VA outpatient-only users satisfied the Zhu et al conditions for POP users, compared to one in seven in the 1998 sample. These POP users represented a total cost of $809 million, or 3.9% of the total VHA appropriation for FY03. The 1998 estimates were $300 million and 1.3% respectively.
In an era of rising medication costs, the VA is becoming an increasingly important source for pharmacy benefits for veterans. Although the financial impact of these patients may be relatively small, the absolute impact is large. Additionally, POP users may place a burden on the VA system in other areas such as wait times for primary care visits.