Health Services Research & Development

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2006 HSR&D National Meeting Abstract


2003 — The Impact of Prescription Drug Co-Payments on the Care and Outcomes of Chronically-Ill Veterans

Author List:
Piette JD (Ann Arbor Center for Practice Management and Outcomes Research)
Stroupe K (Midwest Center for Health Services and Policy Research)
Maciejewski M (Northwest Center for Outcomes Research in Older Adults)
Rosen AB (Ann Arbor Center for Practice Management and Outcomes Research)

Objectives:
Marked fiscal pressures prompted the 2002 VA medication co-payment increase from $2 to $7 per refill and have since led to federal proposals aimed at further increasing veterans’ medication copays. While increased cost-sharing may decrease VA’s medication cost growth, the impacts of such policies on veterans’ health outcomes and overall health care costs are unclear. The objectives of this workshop are fourfold: 1) to provide an overview of research on the impact of out-of-pocket medication costs on adherence, health outcomes, and health care expenditures; 2) to present findings from recently completed and ongoing national studies evaluating the impact of the 2002 VA prescription copayment increase on veterans’ medication acquisition, health status, and health service use; 3) to explore strategies for using VA’s medication data repositories to inform decision-makers regarding future changes in copayment policy and address unanswered research questions; and 4) to identify options clinicians and health systems can use to address patients’ co-payment problems through improved patient-clinician communication, cost-effective prescribing, and targeted benefit redesign.

Methods:
Presentations will include brief didactic overviews of important studies, followed by a semi-structured dialogue with workshop participants on substantive and methodologic topics. Researchers will have the opportunity to discuss issues they may encounter in conducting prescription drug studies, including challenges in using VA national pharmacy data, conducting patient surveys on medication cost problems, and using time-series analytic techniques. Clinicians will discuss strategies they find effective in addressing veterans’ medication cost problems and managing patients who obtain drugs within and outside of the VA. VA policymakers will learn about potential unintended consequences of medication copayment policies and state-of-the-art strategies for restructuring copayments to improve the quality and cost-effectiveness of VA care.

Results:
Health services researchers studying the cost-effectiveness of VA care or interventions to improve chronic illness management are encouraged to participate. VA policy-makers, health system managers, and clinicians engaged in patient care activities dependent upon medication utilization also are encouraged to attend.

Implications:
No prior experience with research methods or data used to study medication cost problems will be presumed.

Impacts: