Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3092 — Effect of Medication Copayment Increase on Medication Acquisition

Stroupe KT (Hines VA Hospital) , Smith BM (Hines VA Hospital), Lee TA (Hines VA Hospital), Tarlov E (Hines VA Hospital), Huo Z (Northwestern University), Barnett T (Hines VA Hospital)

Objectives:
In February 2002, VA raised medication copayments from $2 to $7 per 30-day medication supply. Veterans are subject to copayments for no, some, or all medications based on the extent of their service-connected disabilities and income. Because veterans with several medications may have multiple conditions and be vulnerable to the effects of decreased medication use, we examined the impact of the copayment increase on medication acquisition among veterans with varying intensities of medication use.

Methods:
We examined VA Pharmacy Benefit Management data for a random 5.5% sample of male VA users in FY2001 (149,010 male veterans). We included only medications with >= one 30-day supply. We compared the number of 30-day supplies during one-year periods before and after the copayment increase for veterans with no, some, or all copayments, using t-tests and multivariable count models (controlling for demographics and comorbidities). To examine the effect of the increase by intensity of medication use, we divided patients into four medication-use groups based on the number of different medications before the increase.

Results:
Among low-medication users, 30-day supplies increased 20% for no-copayment veterans (8.6 30-day supplies before versus 10.4 after; P < 0.001) and 8% for some-copayment veterans (7.3 versus 7.9; P < 0.001), but was similar for all-copayment veterans. Thirty-day supplies increased for all moderately-low users. Among moderately-high users, 30-day supplies increased 7% for no-copayment veterans (61.7 versus 66.1; P < 0.001), but fell 2% for some-copayment veterans (59.6 versus 58.2; P < 0.001) and 6% for all-copayment veterans (64.6 versus 61.0; P < 0.001). Among high-medication users, 30-day supplies were similar before and after for no-copayment veterans, but fell 8% for some-copayment veterans (113.6 versus 104.2; P < 0.001) and 12% for all-copayment veterans (109.0 versus 95.8; P < 0.001). Results were similar using multivariable analyses.

Implications:
The copayment increase had greater effects on moderately-high or high-medication users. Among high-medication users, total copayments increased > 300% for veterans with all copayments while drug acquisition fell 12%.

Impacts:
Decreased medication acquisition among moderately-high or high-medication users could potentially result in poorer health outcomes and higher long-term costs, particularly if these medications are used for chronic diseases.